Sunday November 13

Remembrance Day in the UK today. A good opportunity to give thanks for those valiant men and women who have given their lives in service to their country especially during times of war to defend our freedom.

Sierra Leone also remembers and a service was help in the town centre where there is a cenotaph. Attended by the President and various dignitaries from the embassies it caused reasonable chaos to the city centre this morning.

I actually returned to the church I attended 2 weeks ago where we had given sweing machines and scissors and other tailoring goods. Since then they have also received a monetary gift from the crew members of the ship which has enabled them to buy new courrugated tin roofs and wood to begin extending the facilities they have for the children they are seeking to train. there are over 100 children/young people who will benefit from this project. the aim is for them to graduate in April next year.

I gave my lecture/training session on Airway Management and it went well. The use of 'Bob' at the end of the session was well received and it may be that I will undertake further training on other occasions.

In a week where the amount of surgery was lessning we seem to have picked up on the number of cleft lips/palates that we are repairing. In very small children the lip defect is closed and surgery done later to repair the palate if necessary. This week week we repaired the cleft lips of two young people aged 14 years and 17 years. Both of them had quite severe defects and their defects would have been seen as the work of the devil. For both of these youngsters the surgery will certainly change their lives as they will no longer be bullied or subject to abuse from others.

Those of you who know me well understand that I don't view what I do as anything particularly phenomenal or fantastic but rather as the work that God has equipped me for over many years and that I am simply following His plan. We have had a mercy team on the ship for the last 10 days from a church near Mercy ships International operation centre (IOC)in Texas. They have probably been one team that I have been able to interact with most as they stayed on the ship. Often a group like this stays of the ship and then completes off ship projects. But this team were very different and I had meals together with a few of them and really got to know them much better. One of the team was a personal friend that I got to know when I spent a month in texas last year at the IOC as she came on the same course as me and we discovered that we both ran. In fact she was responsible for me running in the Waco half marathon while she ran the full marathon. What has been particularly beneficial is being able to share with her on a particular project and to have her input. God's timing is quite remakable as I had only started on this a few days before she arrived. As the team left the ship today they are remarked how wonderful they thought we were, but I had to remind them them that I am simply following Fathers plan for me and that doing the job that I hav been equipped to do is a joy to me and I hope, a blessing to others.

Tuesday November 8

Well just in case you thought I never actually work here is the evidence. Down in the hold inside a hot, airless, container, counting endotracheal tubes of all shapes and sizes! Thankfully I had a delightful Dutch colleague helping me out. It took us about 9 working hours to complete the job! Sometimes it takes a job like that to really get to know someone and we learned much about each other and our families in that time.

So the weeks of work have continued at a slower pace but with different surgeons, some general surgery - mainly hernias, a little max-fax and being ninvolved with dressing changes on a young girl who needs to be sedated for her dressing changes. She had surgery to separate out her toes along with skin grafts. She is just terrified of the dressing changes but the areas are beginning to heal well and if she needs dressings after the ship leaves there will be 2 of the day workers from the ward to help. They are going to one of the local hospitals having been taught here and will be carrying out dressing changes for some of the other patients too.

Last Tuesday I had the privilege of showing a friends film to the whole crew on the ship. Called Dawn of a New Day it focuses on the work of a South African Plastics surgeon who comes to the ship twice a year for about 5 weeks each time. The film follows him as operates on 3 patients in Benin (where the film was shot). Not available in the UK until the end of November, I had a personal copy as I shared a cabin with Ryley while she was staying on the ship filming. I was exceedingly proud of her. The film is quite amazing. A quite unashamed plug...

Saturday being November 5, it was decided that the Brits would celebrate Guy Fawkes night and have a fun evening. Guy Fawkes was duly made out of a disposable boiler suit stuffed with waste paper and a balloon covered with fabric for his face. Quite a handsome fellow. Silly games in one of the area of the communal areas followed the dinner of BBQ sausages and Jacket Potatoes. Its amazing how much fun can be had if one is simply creative and also quite educational in terms of what people have with them to loan out. The chocolate game with dice hat scarf and gloves, custard in a large serving dish with Werthers buried within, pin the bonfire on the Houses of Parliament, except we used magnets (its a ship - it has lots of metal!!). One the UK anaesthetists who had been on the ship for 3 weeks was a great cake decorator so we even had Victoria sponge decorated using M&Ms complete with Guy Fawkes, a bonfire and fireworks. A joint effort between Louise and myself and jolly tasty! We didn't manage toffee apples but the caramel sauce made to go with the slices of apples made an excellent substitute. A quiz to test our 'Bonfire' knowledge was fun and yes, there were prizes. To cap the evening though, somehow sparklers had been found/bought/brought and we were able to go down on the dock in the dark to light our sparklers - complete with scarves, woolly hats and gloves - of course!

This week I am giving a lecture on Airway Management and no, that's not about managing airlines but patient airways! I'm involving one of the young anaesthetists here and we shall have some fun with 'Bob' our dummy!

As I write we have just 7 days left of surgery so next week will be much quieter again but there's still plenty to do as all the ship has to be packed for sailing.

Sunday October 30

Another week, another dollar. Well I guess it feels like that sometimes except that it’s also rewarding to be here. New staff have arrived, staff that I’ve worked with before, have arrived and it’s all change again. Probably the more demanding part of the work is the constant change of personnel and yet it also has its rewards as the fresh input of staff brings new conversations, new ideas and different ways of working.

There are several core values that ensure we all work towards to the same goal. These are to love God, to love and serve others, to be people of integrity, and to be people of excellence in all we do.

In trying to work to these core values the crew are usually at the least pleasant, the holding open of doors, passing another and saying ‘Good morning’ asking if someone is well and meaning it. From the work perspective it means giving our patients the best chance that we can by doing the most relevant surgery for them.
During the week I have been working with someone I first met up with in 2008 in Liberia. I have worked again with him in Benin in 2009 so to have the opportunity to work together again is great as it means I know how he works, what he likes and to my advantage, he knows how the department is run so I’m not constantly teaching. We have had fun together as we have worked on the best ways to anaesthetize some of our patients who have difficult airways and so cannot have a breathing tube put down in the most conventional manner. Always having a plan B in mind gives us constant challenges. Just how do you work it out when someone is unable to open their mouth because of noma, a disease that has the potential to destroy the lips and gums and causes tethering of the skin around the mouth. There are ways of doing these things but one does have to be creative at times!

The weekend has given me a little time to relax and as I only go shopping when I need to buy something I actually ventured out to the shopping areas yesterday with another couple of UK ladies. Sherrie-Jane lives in Somerset and is working in the ship shop/Starbucks/snack bar on the ship. She found out about a church that is training young women in tailoring. However they only had a couple of old machines. Having visited the pastor and his church, she decided she would ask her local Rotary club to help fund some new machines. This they have done and along with other monies that she has received since making the ships crew aware of the project 4 new treadle sewing machines and an overlocking machine were purchased and delivered to the church. They are now installed in the building they are using and are ready for use tomorrow morning. I along with a Scottish anaesthetist who is here at present and who was the other member of our shopping trip yesterday, purchased scissors for the training workshop. We bought 3 different sizes and presented them today.



Some of the girls with their tutor and one of the new machines in the picture. Travelling to the church this morning was an interesting exercise as taxis had been book but then the driver wanted to charge double the going rate so we decided that all 7 of us would travel on the poda poda which is basically a 14 seater vehicle. Thankfully we managed to find one quite quickly and we were all able to get on the same one. Much cheaper than the taxi too so the church offering benefitted!

This evening we were privileged to have a group of students from the Wells international music school come to the ship and take part in the community service. They are actually in Freetown for 10 days working with a couple of schools and joined us for the evening. Great music, very talented young people including a tall lad with a deep voice singing counter tenor...

The week ahead sees the last week of big surgeries as we begin to wind down. Time now to start packing up and as I shall be unpacking at the other end in Togo I need to make sure I pack it all so I can find it all when I unpack!

Huge apologies to those of you who read my blog regularly and have been disappointed by the lack of the weekly update. I returned home for 10 days as my mother in law had died and it has taken a while to find the time. And that really is an indication of howbusy life is on the ship. There are always activities out of work hours in which one can become involved as well as the work itself involving working extra hours.
Just before I left for a brief sojourn to the UK I had been working in the plastics room. Tertius Venter as a South African surgeon and workedsolidly for 5 weeks re creating faces, giving function to contracted limbs and restrong the shape of faces. Many of these patients have been the victims of fires of one sort or another. Lamps are often fueled by oil and the subsequent burns from accidents with these can be horrific. Equally, young people can be given the chance to use their hands properly as syndactyls are released (fingers joined together from birth). The work requires patience by the bucket load and certainly is displayed by the surgeon.

However coming back to the ship felt like coming home as I am currently in the lead anaesthetic role and probably know more about the anaesthetic department on the ship than the hospitals where I work in the UK simply because I'm here more often!

Having been working in the rooms where many of the large facial tumours are removed has involved difficult intubation tehniques. We have a variety of 'toys' on the ship which help us with this task. Probably the greatest difference here is that no-one minds how long it takes to pass a tube and have the patient anaesthetized. No-one has pressing appointments. this doesn't mean that we take our work any less seriously, just that there is less pressure of time. This is the place where I have most practice ofdifficult airways, a reflection of the workload. I am also trying to gradually sort through the equipment we have and make better use of the hold for storing some of the items and ths create more working space in the pharmacy in the department.

I was able to leave the ship on Saturday and spend the day with a friend visiting a chimpanzee sanctuary not too far from Freetown. The hunting and killing of chimpanzees is forbidden in Sierra Leone because of the risk of extinction. At one time they were a common bush food. The chimps are rescued from homes where the owners mistakenly buy the babies and then realise that they cannot care for them. The average chimp is 5 times stronger than a human and would wreck a home in no time. Close by the sanctuary are some water falls and my friend and I walked to these falls. As rainy season has almost come to an end the rivers are full and so the falls were spectacular. We climbed over some boulders so we could enjoy sitting out a little way from the waters edge and enjoy the peace of flowing water.



As we walked back to the ship after catching a taxi to the edge of the city, I was able to enjoy drinking straight from a coconut, just as it should be drunk and greatfor quenching thirst after quite some walking. In all I think we walked about8 miles that day and my day had started with a run outside with the ward physician who is a like minded runner....

Saturday October 1

A change from last week as I have been working in a couple of different rooms this week. This situation is quite normal here. Anaesthetic assistance spread between two rooms. I have been working in max fax (maxillary facial) and cranio-facial. There is a difference between the two so let me tell stories about one patient from each.

First in room 4 where Dr Gary Parker works for the most part. He has been on the ship for over 20 years having decided to forgo the opportunity of working in the US when he finally finished all his training. We had an 11 year old girl who was very pretty, all except for a large tumour that she had growing from inside her mouth. It had completely taken over the upper jaw on the one side so that she looked as if she had a grapefruit in her mouth, size wise. Her eye was pushed out of line and she had teeth within the tumour. The tumour prevented her from eating normally and she was underweight. (Again situation normal here). We thought we might have a problem passing a breathing tube but in the end it wasn't so difficult and we weren't too long in putting her to sleep.

During the surgery she needed blood. As a blood donor onboard I had been warned the night before that I might be required to donate a unit and therefore it wasn't really a surprise when the call came. Quite something to give a unit of blood and ten minutes later see it going into your own patient. One of three untis she received that day. There are not the facilities onboard to store blood as there at home and so we keep our blood warm by drawing it from volunteer crew members as its required. It does mean that patients receive whole blood and it does not need warming, but it does need a close match. She's making a good recovery so far.

My second story, although there are several from this room and its hard to choose, is a little girl 15 months old who had a small encephelocoele. (Swelling on her head) When she was seen by the anaesthetist, he realised that she had a problem with her heart. In his normal practice back in the US he works as a cardiac anaethetist. She appeared fit and well so it was agreed to go ahead with surgery. When she came to the operating room he was able to perform ultrasound of her heart and found that she had an enlarged heart. Surgery was performed and again she has recovered well. Her mum knew nothing about a problem with her heart. To talk to mum we had to use another patient who spoke the same dialect/language. Imagine, I'm talking to a translator in English who translates to Krio to the patient translator, who then translates into the mum's language. Now you understand why consultations can take so long! But to also have an anaesthetist onboard who could carry out a cardiac ultrasound and he was only here until yesterday morning. What's more is that I have contacted an organisation I know about through the time I spent in Haiti with another nurse. Truly Father organises these things and I am ever amazed by what He does.

But just one other little one to mention, as I said I've been working in a room with german cranio-facial surgeons and we have placed a V-P shunt in a baby this week. The shunt drains off the excess fluid from the ventricles in the brain and it passes down a tube which is placed inside the body to the peritoneum/abdomen. Not only are these uncommon in Sierra Leone we can prbably say with a degree of certainty it was the only one performed in SL yesterday. A crew member arriving from the States brought the necessary kit over. The baby is 11 months old and weighed 6kg. I'll let you know how he does.

And today - I'm on call and need to do chores, washing, ironing, vacuuming and hopefully later, if it stops raining sit out on a deck and read!

So my work has continued in much the same way this week. I have continued working with the team in room 2 where there has been much plastic surgery completed and in room 1 where a general surgeon from Uganda is working. Yet again old friends have come returned - notably the general surgeon, having worked with him last year. The main focus of general surgery are hernia repairs, again a simple operation in some ways but one that makes life so much more comfortable. Oneinteresting evening was spent listening to the plastics surgeon give his story of how he started and continues to work on the ship. He comes out about twice a year usually for about 5 weeks each visit. About 8 of us just sat round on one of the outside decks to listen. A very interesting hour after working together for the day, which of course included a Starbucks 'run'.

We have tried to organise an evening out as an anaesthetic group but failed miserably this week as one can be working late and of course another is always on call. We did manage to eat together eventually but by eating on the ship at a special 'Shabbatt' meal on Friday evening. As part of a Spiritual retreat on the ship the meal commenced the weekends activities. I had reserved a table and we did manage to eat together. The tables had been laid out specially and it was a good time to just sit and talk together. Another anaesthetist had joined us just the day before but he was a 'repeat offender' - i.e. like me had been to the ship before. The rest of the evening I spent going round an interactive exhibition looking at the Tabernacle and its various parts. Someone had been very creative. On a floating metal box where space is limited it was seemingly possible to create special areas and to make good use of the available space. Much as candles are lovely there are not allowed on the ship if they produce a naked flame. There are battery operated ones available however and these were used to good effect.

Beach was asked for today and so to the beach we went. Having found a good taxi driver 5 of us piled into a car and travelled about 35 miles I guess(I didn't measure the distance) to a beautiful beach. Very quiet, sandy, a few shelters of the thatched variety and an order for lunch taken and delievered. SOunds idyllic and it was a great day apart from the rain and teenagers. Some problems are the same the world over! It was good to get away from the ship, and see the country if only in a small part. What is wonderful about being here at this time of year is seeing everything so green. It's the first time I think that I have been to West Arica and seen such vibrant green colours.

Saturday September 17

Four days worked and I'm feeling at home. I have spent much of the week working in the rooms with surgeons who specialise in reconstructive plastic surgery. All these cases have a story to tell. Many involve accidents with oil lamps. Others are quite literally war wounds but from civil war. A complete history is not always available as the mind has a way of blocking out atrocities and sometimes injuries incurred as a young child are not remembered clearly.

One young lady comes to mind whose burns were so severe that her abdomen was not only covered with scars but had a long keloid scar that pulled up skin from her thigh making a long line of scar tissue. Quite how she stood upright I cannot imagine. She had no hands but stumps and one arm was particularly damaged by scar forming a web under her armpit. And yet she was breastfeeding....

It has however also been a week of mirth, merriment and joy. Meeting up with many friends among the operating rooms as both nurses and surgeons are onboard again. But also to meet up with those outside of my own small workplace but without whom there would be no community. The ship is a microcosm of any community and I have talked with teachers, photographers, engineers, hospitality and cleaners. Aside from that, helping out with the Starbucks as I did last night. A relatively quiet night being Friday but it gave me chance to remember how to make a frappucino! 'Happy Frappies'are popular. Simple - A frappucino served with a smile.

I have been fortunate to be put in cabin for 2 on the fourth deck. My walk to work is approximately 30 paces and half of those are down a flight of stairs. I have started running too and realised just how much I have to do if I gain a place in the London Marathon next year!!

For now, the washing is making steady progress in the machine and I'm on call for the day so the rest of the day is my own.....