Tuesday, March 30, 2010

The most beautiful

Last year you heard the stories of Anicette. Chicken little, our feeding program baby who gained the weight she needed to before our skilled surgeon mended her cleft lip. She was one of the ones who made it. We saw physical transformations, but more than that we saw spiritual life breathed into that small family. Her mama loved that precious baby so much, and we all loved them with such excitement. Their story brought joy in the face of despair, especially with the work that brought so much heartache last year.

I saw Anicette and her mom on Friday. I walked past the sign on the infant feeding room, a poster that has a picture of Anicette smiling and fat on it taken right before her surgery last November. My heart jumped as I saw her mama, but so quickly that feeling turned to sickness when my eyes caught sight of Anicette. 4.2 kg at 14 months. She was the most malnourished child I have ever seen, that I have ever touched. Her smile was gone, her eyes didn't shine the way I remembered. Her cry made me nauseous. It was clear she was near death, and we all felt the pain of the situation.

All the nurses who knew her could hardly believe what we were seeing.

We suspected last year that she had some sort of metabolic disorder. We knew she wasn't absorbing nutrients, not gaining weight despite regular feedings. Whatever the case, it doesn't seem important now as I think of her story.

Anicette died yesterday. She was on our little A ward, surrounded by a ship with people who loved her. Her mama I'm sure wept in the arms of my friends who are carrying a burden too heavy to describe. I got the news from Ali who knew I should hear about the details while I am traveling this week.

Its so surreal, too much to understand right now. In these cases you have to switch from extreme joy, pure hope, to death. Its not something I will ever get used to, I pray I never do.

My mind keeps wandering to Ani and her mama. I know in the deepest corner of my heart that she is with Jesus, restored to perfection, crowned with beauty, and peacefully laying in His arms. She doesn't know hunger anymore, she will never again feel the sting of pain.

For us though, for us its hard.

Please pray for her mama. She is 4 months pregnant and we learned she lost another baby before Anicette who also 'couldn't eat'.

I read through some of my blogs about Anicette as I reflected on how such a tiny baby can impact my life in such astounding ways. This pretty much sums it up:

"She cooed and smiled, giggling as I kissed her belly and her cheeks over and over. That baby is seriously the most amazing gift of joy I have ever been given. She has been my comfort on so many days this year. She is one of the most beautiful children of Jesus I have ever seen and I love her with everything in me. My chicken little." Dec 4, 2009

Her full story is here.

Wednesday, March 24, 2010

This face

This face makes everything worth it.
The pain, the tears, the stress, I will endure it for this little boy. I wish I could accurately describe the magnitude of the joy in my heart as I sit here and type.
We walked into the small ward at the hospital this morning to see Gerald receiving his first dose of chemotherapy. Michael got his right after.

In the moment Gerald sleepily reached out his hand in greeting and smiled shyly in response to a kiss on the forehead, I knew I was right where I was supposed to be.
This face represents why my life looks different than some peoples, why I stay here in Africa. This smile lessens the pain of only seeing my family once a year. This face speaks of Gods goodness and His beautiful plan. I find comfort, solace, peace, affirmation, love, and raw, true joy in this face.

This little boy has just as much worth as any of us. He should receive the results of our best efforts. He is deserving of every ounce of stress and heartache. He is worth the work, the hours of research. He is more than enough of a reason to give up the world and follow Jesus. I gladly die to my own will, to my own comforts, all for this smile.

"Each one of them is Jesus in disguise" - Mother Theresa

Isaiah 41
9 I took you from the ends of the earth,
from its farthest corners I called you.
I said, 'You are my servant';
I have chosen you and have not rejected you.

10 So do not fear, for I am with you;
do not be dismayed, for I am your God.
I will strengthen you and help you;
I will uphold you with my righteous right hand.

17 The poor and needy search for water,
but there is none;
their tongues are parched with thirst.
But I the LORD will answer them;
I, the God of Israel, will not forsake them.

Monday, March 22, 2010

Oh, hey God

Last week I prayed about my time here in Togo. It seems awful to say I was bored, maybe a more appropriate term would be I was in a 'quiet' season. Who am I kidding, I used the word bored.
I had worked for a few hundred hours preparing for the Burkitt's program. My excitement grew, I knew the kids would show up, there was no way God would prepare us and not deliver.
Or maybe I was wrong...
Last week there were no kids. I got an email that the chemotherapy had arrived on board. Great, but we have no kids, no contact at the hospital (I'll spare you of those incredibly annoying details. Basically we were trying to set up an appointment with a 'director' who doesn't exist. Moving on)
Last Monday I had a day where I put it all out there.
Ok, God. If all that wasn't for this year, if the inpatient aspect of treating the kids on the ward isn't meant to be, its ok. I trust your plan. Just show me though, because I'm slightly confused about why I am all the way in Africa, sitting and having some 'quiet' time.
Although I didn't use the 'b' word I have a feeling God already knew that one.

Wednesday I get a page to call the dental clinic. A little boy had accompanied his uncle who needed some fillings for his cavities. The dentist (who happens to be my friend and has heard my spiel on Burkitt's) saw the boy and assumed he was the patient. When he didn't sit in her chair she investigated further, thank God she did. Within hours the boy and his uncle were on the way to the ship with a biopsy scheduled for Thursday. I grabbed a translator and we set off for the gate to meet them and bring them through the secured gates. The boy arrived and a random man called him over.
"Why has this boy not gotten treatment?" He implied
Who are you? (I said in my head)
"We're working on it, we are doing a biopsy tomorrow" I politely responded.
Turns out he was a local surgeon. Thankfully I had kept my earlier question to myself
"Do you treat Burkitt's in your hospital. If we diagnose him tomorrow can we bring him to you?"
"Yes, you should be our partner"
Ah, yup. I think that would work.
The conversation was slightly different, but I will keep it short for your sake.

And so the story of Gerald was born, and our relationship with the local government hospital as well.
Gerald is a grown man in a little boys body, and yes, I already love him for those of you who may be wondering. I saw his slide in the lab with my own eyes. When I peered into into the microscope, hundreds of round purple lymphoma cells appeared.
We got him, our first Burkitt's patient.
It seems sick to be excited about a child having cancer, and its not that I am excited for that fact, but I am excited it is something we get to treat. I believe I am here, right now, at this very moment, for Gerald and any other child who comes through with Burkitt's. So yes, I am happy about this little boy with cancer.

We set off for the hospital on Friday morning with high hopes. Gerald sat in the car with us and warmed up within a few minutes. It may have been us dancing to the black eyed peas ( I asked him his favorite music and he said 'dance') or the sheer fact he was out of the sometimes-intimidating ship.
When we arrived we began the typical back and forth with how treatment would go. Things were predictably vague with how they would go about doing it, but we felt ok. When we got to the ward where we would leave Gerald things turned a bit. The children occupying the scarcely covered beds were malnourished and sick. When I leaned over to hand one particularly sick boy a sticker, the stench of stale urine filled my nostrils. They brought in a mattress for Gerald, stained and dirty, with no offer for a bed sheet. We decided to go out and buy some sheets. Here, you don't look for the nearest bed bath and beyond, you simply go to the corner and find a woman selling used bedding. 3 bucks for a top and bottom sheet, even a pillow case thrown in as well. We chose white, figuring if it was dirty we would know more readily. The 'top sheet' was a table cloth with embroidered flowers in the center. Very nice, really.

We returned, made his bed, and left feeling pretty good that Gerald would begin treatment. We were tired, but felt good about our progress. In desperate need of some food and a shower, Becca and I split and decided to join forces after a quick nap.
Those plans went down faster than we could get to the dining room. I got a call from the OR. Another little boy we were sure had some form of cancer causing his eye to bulge away from his face, had just gotten out of his biopsy. Diagnosis: probable Burkitt's.
I had been thinking it, and at that moment I realized something. A note to the wise:

Don't tell god you're bored if you don't want Him to answer.

Thankfully, both Becca and I were happy He answered, and ready to go. We made our back through the dusty streets, walked over the cracked and wobbling drain covers, and into the office where we hoped to enroll little 1 and a half year old Michael in our assumed protocol.
Not so.
Turns out no one planned on starting treatment on Friday. They ordered a litany of tests, some of which we had already done, and sent us away feeling totally defeated. Becca returned Saturday on her day off and she saw more of the same, except now, the urgent treatment wasn't going to begin until Wednesday.

I woke up this morning with puffy eyes, a result of the tears cried last night over the injustice of this whole situation. I hated it, I wanted it to be different. I am willing to carry this burden, I am, but its a different story when the kids are right in front of you. Its easy to plan and to talk, but when you have giggled along with a 4 year old and watched how a mama cares for her only son who has yet to see his second birthday, things change. Objectivity becomes a distant memory. Your heart breaks in ways you couldn't imagine, and taking one more step seems not only impossible, but pointless.
So I prayed, and my mom prayed from more than a thousand miles away while I quietly cried in my room, not the first time this scene has unfolded while I have been in Africa.

This morning we were greeted by the stern face of the head doctor of pediatrics in the local hospital. He didn't appear terribly pleased to meet us, and both Becca and I could have thrown up on command at that point over the dread we had in our stomachs.
I smile right now writing this. I told my mom I liked being surprised by God, but at the same time I can't believe its possible to still manage to be surprised by Him.
Halfway through our meeting, a weight was lifted. All of a sudden we were talking about parnership, about how we could help each other. We all were agreeing and chatting about how we could work together.
We left, physically, emotionally, and mentally feeling lighter.
Thank you, God. You did it again.
He never fails.

Last Wednesday, the day I met Gerald, I wouldn't have normally been outside of the car. We were just waiting, expecting to see them and have them immediatly follow us into the port. They were late though, and a man knocked on our window while we waited. Turns out he had come from Benin and had some complications from his surgery nearly a year ago. When Gerald and his uncle arrived, I was trying over and over again to get a call to go through to the ship in order to ask what to do with the man from Benin. Had we not been delayed, and outside of the car, the Dr. wouldn't have seen Gerald and asked us about him. I would still be trying to get through to a director that doesn't exist.
That morning when I had heard of the possibility of a Burkitt's patient I immediatly prayed because although I was excited, without a hospital I wouldn't have anywhere to bring him.
Before that, if the dentist hadn't thought to take a closer look at Gerald, he would have walked right through without us ever knowing.
Why did the uncle even bring him to the dental clinic with him?

Do you see yet that this isn't coincidence, that there is a greater power working out every detail of every day? Should I go on? Because I could. I could type for hours about every instance I have seen God in, just over the last 5 days.

Gods plan is perfect. His timing is impeccable. His love is extravagant.

And here he is. Gerald. In charge and ready for business.

Little Michael. Today when we walked through the courtyard of the hospital his smiling mama ran up and wrapped her strong arms around us. Michael was sporting a matching wide smile. Until I kissed him. Too soon. Too soon.

Wednesday, March 10, 2010

A sweet melody

I'm not sure how to start this post, besides by saying this sense of not having words is all too familiar. Or at least it was a few months ago, and now again today.
Since returning to Togo I have been meaning to call some of my patients from last year. Its funny, I want nothing more than to hear how they are doing and smile while a translator tells me they are well, playing, and happily enjoying life. Maybe that's why I haven't called until today, I know the translator won't say that. I know the news will not always be happy, but something deep inside is desperate to be protected from more bad news, more heartache, more hot tears running down my face.
The first call that went through was to Anicette's mama. Although the person on the other end was not her, he clearly knew us as evidenced by the loud "Ah!!" heard around the small office we were calling from. We didn't have to even ask, they are already planning their trip to see us here in Togo minutes after they answered the phone. Just hearing my friend ask how she was doing and seeing her response brought tears to my eyes. Chicken little. oh chicken. I can't wait to hold that little baby again.

We tried Luc's phone but the network told us again and again that our call, no matter how much we wanted it to, was not going to go through.
Then my eyes fell on Maurice's number.
When I was at home over Christmas I had a lot of nights when I woke up thinking about the kids from the Benin outreach. I never knew if I had been dreaming or just thinking about them, but for hours my mind would trace back over the moments with them. Those kids are still never far from my thoughts.
One night I woke up as if I had been hit in the stomach.
Maurice. He died, he's gone.
I quickly put my heart before God in prayer.
Yes, Suzanne. He is with me now. He is home, here, with Jesus.
I felt peace descend, I knew in my heart he was gone, and I knew it was ok.
I can't remember if I told anyone besides my family about the dream at home, at least not right away. I told people on the ship when I returned, people who knew him, but I think that dream was one of those sacred moments I kept between God and I for a while.

Today I knew it was time to call. I knew what his dad was going to say, but that self preservation in me was dying to just let a few more days pass, maybe another week.
"I'm sorry, my condolences", my friend said in french.
My eyes blurred, no use really in trying to hold back those kind of tears.
She told his father about my dream, how we believed he was in Heaven.
We are so sorry, she said.

Maurice was my first pediatric patient in Benin. It is clear to most that I live to work with kids. Last year I knew my role was meant to be in Palliative care, where I would be caring for adults, but I still longed for the little ones. I met Maurice close to the beginning and I admit, unashamed, that he was one of my favorite kids. ever. I loved him so deeply and felt his sweet love in return every time I held him. He taught me so much. He had seen and experienced more in 5 years than most of us will see in a lifetime, and he never failed to smile.
After I got the news this morning I walked down to deck 3 in search of my friend who also knew Maurice. As I neared the bottom of the stairs, the memories flooded my mind. I could see Maurice, feel his hand in mine as we ran up and down the halls, over and over again. I could see his face with tears in his eyes as he watched the needle I was holding get closer to his arm when I would draw blood. He never fought me, and always forgave quickly, showing his grace by slipping his hand into mine.
My mom joked last year saying; "I don't know what you two will do without each other when its time to leave".
Our last day with Maurice was hard. Juan, Sarah, and I went to his house. Each of us were captivated by this little boy.
"Maurice, do you know Jesus loves you?"
he nodded yes...
"Maurice, tell us something about Jesus"
"The Lord heals" He replied.

We prayed he would go gently, that he wouldn't suffer and longer. We cried while we prayed, and then we said goodbye.

My heart aches for Maurice, at first I was trying to justify the tears. I knew he was gone before we called, I knew it was better that he not suffer, why then should I cry? If I learned anything last year, it was that I don't have to have a reason. The tears make me feel alive, connected to the heart of my work here. They make me feel connected to God too, to His heart.
As I sat on deck 7 during lunch, overlooking the palms and warm beaches, I felt God in the breeze. I heard him whisper into my soul.
I'm here, Suzanne. I know you loved him.

I just came up from B ward. The benefit of having a hard day on the ship is that there is never a lack of 'therapy' babies just steps below wherever you happen to be. Today's best medicine is a toss up between Mako, an 8 year old little girl with an infectious giggle, and baby Pauline, the softest child I swear I have ever held.
I put my lips to Paulines ear, and kissed her quietly. Her hands found my face and rested there, her head grew heavy, her warm cheek pressed against mine. She cooed as I kissed her again and again.
Restoration of the heart is such a sweet, sweet melody.

Sunday, March 7, 2010

Both Sides

Thursday was quite the day on B ward. I walked in to see a ward that only two days before was sparsely decorated with patients, nearly full with an noticeably increased noise level. The two little boys in beds 1 and 2 caught my eye first. At two and five years old their cleft lips are a large, very obvious disfigurement which send their teeth jutting out in different directions. Still, no cleft lip can stifle the smile of a child. When they break through the initial uncertainty of having a yovo as a friend, the smile that comes next makes everything ok. All is truly well in the world when you have a child smiling widely at you.
Now you have met Kodjovi and Kokouvi.

In the corner Pascale was already wiggling around at the early hour of 7am. I saw his name on the list days ago and was excited. A three year old getting orthopedic surgery=casts from hips to toes=cute. And there he was in front of me. He stopped wiggling when I (too quickly) approached him. He fought the fear and gave in with a small smile, suspicion still lurking in his black eyes.

The morning progressed, we rounded with the doctors, and then I spotted an excited looking boy tip-toeing around the ward. Koffi has the sweetest little face. He is shy but friendly and if one thing is true it is that he loves his dad. He tip-toes around because his achilles tendons are too short. He is in the OR now getting them fixed.
Then there is little bow legged Bobo. On Tuesday, before his surgery, I played soccer up on the deck with him and another bow-legged patient awaiting surgery. We were teaching them moves to get past each other, but they always resorted to kicking the ball through each others legs. I guess its fair if both play off the other's handicap. Bobo was not too thrilled with us when I was getting ready to leave. Before I left, you could hear him behind a curtain pleading with oooooo oooo, eeee, eeeee's while his nurse tried to help him go the bathroom. He initially smiled at me when I went to him in the morning, until I touched his exposed toes. The look of horror that crossed his face, shocked that I would touch his injured extremity, was too much for me to handle without smiling. Those casts are not fun when you're 6 either.

Next door, A ward is housing our feeding program babies. Francois, the little one I mentioned here before we even arrived, is now big enough to have surgery. He is a bit over 3 kilos and looks like a giant compared to the 4 other babies currently working to get fat. Anne and Anna are 12 day old twins who brought tears to my eyes when I uncovered their tucked-in bodies from the soft blanket they were carefully wrapped in. The night nurse was an advocate for bonnets on all of the babies, and I instantly appreciated her persistence in finding them when I laid my eyes on 5 tiny babies wrapped up with knitted caps on their heads. Anne has bowed legs and now weighs in at 1.9 kilos wearing the smallest casts I have ever seen in my life. Before that she was 1.7kg. God bless that little baby.
The other two are boys, Romeo and Marius. Need I say more? I think not.

It was one of those mornings. Ali and I were teamed up again, this time with my trusty friend orienting me to the world of charge nursing on the good Mercy Ship. We were busy but happy. We had heard news earlier in the morning that one of the little 8 year old girls had an inconclusive SIS test. Here on the ship, we use the term 'SIS' rather then HIV in an effort to protect the patient from the whole ward of listening ears. They were still going to do surgery, and re-test in a few months. The woman a few beds down was not so fortunate. Her test results weren't inconclusive, they were positive. We set up for the counselor to meet with her. Shes only 34, a victim to an unfaithful husband and now a lifelong disease.
Across, in another bed, we got the news that the 14 year old awaiting surgery was pregnant, and only in her first trimester. The counselor was getting her workout, carrying the burden of the news that this little girl had miscarried the year before, at only 13 years old.

After the two women left we sighed the kind of sigh that I have only experienced here. Kodjovi and Koukovi were still giggling in the corner, Koffi was tiptoeing around, shrieking in excitement over the bubbles being blown by a nurse. The babies in A ward were bundled up, safe and secure in the big beds with their mamas.

Life is about balance. I like the up close look I have to life in Africa. Its hard, and sometimes your heart aches a little extra, but that also can make the good moments shine even brighter. Little Koffi came back Friday after his surgery held by his dad with light blue casts on his legs, He slept sweetly for the first few hours back. Kodjovi screamed like only a 2 year old can who is hungry, and mad at everyone involved with doing the surgery on his little face.
Life B ward continues, and we continue to dwell on both sides of joy and heartache.
Thank you, God. Thank you for letting us be a part of this.