Home for the Holidays

I find myself reluctant to write this post, as it will be my final entry for this trip and means that it is officially over. It is so hard to bring the past 2 months to a close, after so many wonderful people, places and experiences. However, returning home to my family just days before Christmas has helped to soften the blow of leaving Madagascar. It certainly felt like a magical homecoming after 3 long days of travel, flight delays, a missed international flight, lost luggage and extremely swollen ankles. Listening to “I’ll be Home for Christmas” on endless repeat while circling the Dallas skyline glowing with holiday lights, it really did feel like the ending to a Hallmark Christmas movie.

A welcome sight after a long journey home

Of course, Christmastime on the Africa Mercy was special in many ways, due to the 30+ nationalities represented in the ship. Christmas traditions abounded, but my favorite tradition by far was the Santa Lucia processional. My Swedish roommate played Santa Lucia, and a group of Swedish and Norwegian men and women joined as her chorus in singing traditional songs. From celebrating these different holidays to making Christmas cards with the patients, Christmastime in Madagascar was very unique and a pleasant removal from the typical commercial bustle this time of year.

Santa Lucia in the Swedish tradition

In the last weeks before my departure, the clinic stayed very busy and at times we were bursting at the seams with patients. As a result, I was able to participate in one of the largest dress ceremonies for our OBF patients. After getting to know many of the patients for almost 1 month, it was a particularly special dress ceremony. Happily, many of the women in this final dress ceremony had very supportive families and husbands, which is a rarity for the VVF patients. We celebrated the husbands who stood by their ailing wives for years, staying true to wedding vows taken so long ago. It made the goodbyes much easier, knowing that the women I cherished so much would be returning to a brighter future surrounded by faithful loved ones. On top of all this, the local Malagasy nurses passed their exams and were taking on more responsibility in the clinic. Sad as I was to leave, it was very fulfilling to see the clinic flourishing in so many ways before I left. I know that the team there will only continue to grow and nurture this clinic so that many more women and families can benefit from surgery and rehabilitation.

One of our patients and her sweet husband

A full celebration at this dress ceremony

Before leaving Madagascar, I did my best to squeeze in every last activity. From running along the beach to eating lychee ice cream, I savored every last moment in this beautiful country. Perhaps the most unexpected activity was that of bathing pigs. One of our day crew told us about the 17 pigs he kept at his home, and invited a friend and I to help out with the chore of washing his prized possessions. This was quite a treat and one I won’t soon forget! The pigs were kept in pens, as a part of his small compound within a neighborhood. Our friend welcomed us into his home, resembling an efficiency apartment, which he built in just one day. From getting water out of the pump to snatching piglets from their ferocious mother, it was a unique glimpse into the life of a farmer in the city.

Last run on the ocean road

Hungry piglets pre-bath

Final farewells and selfies

After saying goodbye to friends in Tamatave, I traveled with a large group of volunteers to the capital city Antananarivo to catch a flight home. After an 8 hour bus ride through magnificent countryside, we arrived in the capital with enough time to explore just a little bit. A fellow volunteer and I trekked around the town and even found a vantage point from the former gravesite of the Queen of France. After this brief diversion, I was off to Johannesburg, then Amsterdam and finally US soil.

View of Antananarivo, a vast and sprawling city

Found a friend in this Scottish volunteer, only to say goodbye just hours later

I wish I had some clever words to say after these past 2 months, but to be honest, I am still trying to process all that has happened in this brief timeframe. However, I know that I am grateful for the opportunity to travel to Madagascar, to know and love the people of this nation, and to serve alongside many gifted individuals from around the world. God's handiwork around the globe continues to be evident to me, in the form of unique and diverse individuals made in his image, in the beauty of landscapes painted by his hand, and in his outpouring of grace and mercy for and through his people. Psalm 66:1-4 "Shout for joy to God, all the earth; sing the glory of his name; give to him glorious praise! Say to God, "How awesome are your deeds! So great is your power that your enemies come cringing to you. All the earth worships you and sings praises to you; they sing praises to your name."

Hope and Healing

It seems inevitable that on a foreign medical mission trip, many questions and discussions should arise on issues of responsible charity, sustainable outreach, capacity building and other such topics. Add to this the idea of prevention and we involve everything from the educational system to agriculture to international relations. Amid the lofty questions of how best to do missions or what is socially responsible, there are real individuals currently experiencing the full force of illness, poverty, disease, etc. I have been challenged to balance the intellectual aspect of missions with meeting the urgent needs before me. It may feel like an exercise in futility to stop this cyclical pattern of poverty, yet when I look at the beautiful faces before me I can't help but come alongside these individuals and share in the real hope God has given us.

Over the past month at the OBF clinic, we have been overjoyed to see a 92% dry rate for our patients, indicating successful surgery and healing from fistula! We recognize the widespread impact of the fistula on these women, as the condition often limits access to education, employment options, and social interaction. In an effort to ease the transition back to work and chores and social standing, we have initiated basic teaching programs on math skills, writing the alphabet, telling time, and various health topics. This is intermixed with Bible stories, praise songs and the occasional dance session. I think it is every nurse's dream to work in such a holistic treatment program, so it has been a real privilege just to be a part of this clinic. 

We can't exactly take photos of patients while we are working, so here is a shot of some of the team during break time. Tough crowd, eh?

It turns out that our team is not the only group excited about this clinic, as we have hosted many interested parties over the past month, including well known corporate donors, global charity groups. and even the US ambassador. They all share our enthusiasm, not just for the 20-30 patients in our clinic on any given day, but for the ongoing projects that are stemming out of this clinic. Since my arrival in late October, the volunteer Mercy Ships nurses have been training local Malagasy nurses in safe nursing practice and care of the fistula patient. The transformation in these nurses has been so encouraging to witness over the past 2 months, as we are preparing to turn the clinic over to this local team in the next couple of months.

Looking to the beautiful women who have inspired this clinic, our fistula patients each carry a unique story and we have the chance to celebrate each of them at our dress ceremonies. It is impossible for me to know or record each of their stories, and even a glimpse into their life could fill pages. I hope I have the opportunity to share some of their stories with you when I arrive home, but for now I'll just share a tid bit. We have treated very young to relatively old patients, creating a multigenerational family dynamic in the OBF ward. One of our patients is a young teenager, rescued from a local hospital after a traumatic labor and fetal death. It was a worst case scenario in every regard, from the situation of her young pregnancy to the gruesome death of her baby. She was found emaciated, covered in sores, wet from her fistula, angry and unreceptive to help. She continually refused medication and food, and fought the nursing staff on every approach. Yet this young lady has now been nursed back to health, is smiling and cooperative, and is recovering from a fistula repair. This girl is on an arduous journey that is far from over, having experienced more trauma in her short life than any of us may know in a lifetime. Having watched just a small part of her transformation, the parallels to the Christian life are remarkable. Wasn't I also filthy and saturated in sin, angry and turning away from God's love? Yet God continued to pour out his love for me, overwhelming me with his grace and restoring my soul back to health. It continues to be a hope and prayer that this young patient may one day find true healing, not just from a volunteer surgeon or nurse, but from the saving grace of God through Jesus Christ.

Since I cannot share each story and a picture is worth a thousand words, I have included some pictures from our dress ceremonies.

When I am not being filled up at the clinic, I have been enjoying time with fellow volunteers from all over the world, exploring Tamatave and surrounding areas. Roadside scenes include bountiful lychee stands, fast food tents, and goat herding through the city streets.

 Shopping is always an adventure, and I even collected Christmas decorations from the bazaar the other week. 

It has been so fun to work with our local daycrew and I got an invite to celebrate at a birthday party with one of my new Malagasy friends. 

A nearby zoo housed chameleons, hiking trails, and some poor caged lemurs (probably safer for me that way).

On top of all of this, I was able to travel to a nearby island called St Marie for a long weekend with two of my roommates. I can hardly believe I was able to see this amazing place and was actually moved to tears the first morning I woke up to the beautiful view of the ocean (that or it was fear of the giant cockroaches clinging to my bug net). On the small island we were treated to waterside meals, canoe rides, hiking, snorkeling, kayaking and many more wonderful things that I simply won't bore you with. St Marie is an enchanting island and it has pulled in many Mercy Ships volunteers with its Siren's call.

I'm now in my final week here, experiencing the mixed feelings of sad goodbyes and eagerness to be home with family and friends (and dogs). I'll hold off on closing remarks for now, as I still have 5 days left in this country and anything can happen in that time period.

Thanksgiving

I'm glad it's Thanksgiving today, as it gives me a free pass to openly express gratitude for the blessings in my life without sounding like a total sap. The beauty of these past weeks has led me to reflect on the lifetime of blessings I have been showered with. It has also humbled me in ways that remind me of what an undeserving recipient I am.

Early in the week I visited a small island called Prune Island, just a short boat ride away from our ship. It is notable for the lighthouse maintained by one man, built in the early 1900s and the tallest in Africa. Climbing up with a small group of girls from the clinic, we were treated to spectacular views of the island, a white and turquoise shoreline, and ocean all around.

   The approach to Prune Island

 Rewarding view from the top of the lighthouse

Although this felt like the pinnacle of beauty, we went on to discover many more treasures on this island. Our guides took us to see giant bat nests, which was surprisingly enjoyable. From there we trekked along the shores to find starfish, sea cucumbers, edible bugs, coral, and polished sea shells. A few of us enjoyed snorkeling through the shallow waters housing coral, angelfish, sea urchins, and many other tropical wonders.

Apparently these bugs are a delicious treat, but I saved mine for next time

   Our trusty guide pointing out the starfish, which can cause intense itching if you touch it.

I will forever carry the memory of this day as I received a scorching sunburn on my back (probably from too much snorkeling!) that has yet to fade. Looking back on that day, I don't think I fully absorbed the beauty around me, but instead left with a sense of wonder and awe. To think that the One who created such things, tucked them away in an undiscovered corner of the world for His enjoyment, and then let me in on this secret....it is really too much for words.

The unbelievable view when we landed onshore

 The water was so clear, snorkeling wasn't even necessary to see the colorful sea life.

I really am working full time here, but after a week of work I was able to go on another trip to a lemur preserve called Palmarium. This time there was a large group of Mercy Ship tourists, and all 30 of us packed into a passenger boat and cruised 3 hours down a series of lakes and canals to our destination in the jungle.

I was trying to channel my inner Katherine Hepburn from The African Queen, but it wasn't quite the same without Humphrey...

At the preserve, we stayed in bungalows reminiscent of Swiss Family Robinson, where our patio was a gathering place for the local lemur population. We were treated to fresh fruit juices, lots of fresh bread, bananas flambe, and lemurs jumping on our tables. Our guides took us on a night hike to spot the rare, nocturnal aye-aye lemur. These critters are quite similar to a raccoon, but with beady eyes, sharp teeth, and a "boney" finger for digging into coconuts. Not exactly charming animals, but an interesting glimpse into the diversity of wildlife here.

Standoff with a hungry lemur on our patio

One of six aye-aye in this region. 

During daylight hours we hiked through the preserve to find a variety of adorable lemurs, which you can see in the pictures below. Fun fact about lemurs that I did not know until after this trip: lemurs like to be fed and don't mind being held, but do NOT like to be petted. I discovered this after the lemur on my shoulder bit me. Apparently lemurs also carry rabies, so I was quite relieved to find my callused hands seemed to deflect any skin penetration. This close call was followed by a snake discovery underfoot while taking photos of the flowers. All in all, it was a fun weekend and a perfect precursor to Thanksgiving, as I was extremely grateful for having lived through the trip.

Perched on our patio

Another beautiful variety of lemur

A very old tortoise was an added bonus on our trek

Enjoying these soft, seemingly cuddly creatures "pre-bite"

This is not the actual bite incident, but I think it looks close enough

Interesting plants abounded; so many that I don't even remember the name of this one

Thankful that I did not get a nip from this guy! 

As I lay in bed after my travels, assessing for early signs of rabies and/or malaria, I considered the helpless, vulnerable state so many ill individuals find themselves in here. There is no emergency evacuation and no option to transfer to a specialized facility. I can't even begin to imagine the fear that would rise up at the first sign of a lump or a fever, knowing that effective treatment is probably not available. I considered myself incredibly blessed as God protected me throughout this weekend, let alone a lifetime where I have been surrounded by sanitation, hospitals, nutrition, shelter, love. I know God has me planted exactly where I need to be, and yet I can't help but wonder how I got to be so blessed?

I guess it is a reminder of God's free and bountiful love that He has lavished on me, unmerited, undeserved and inexplicable. He has already given me the greatest gift of life through Jesus Christ, despite the fact that I am a sinner, utterly undeserving of His love. I don't know why He has chosen me or why He continues to pour out blessings in my life. There is no option other than complete surrender to His love, an overwhelming sense of gratitude, and an unending list of thanksgivings.

And now, thanks to each of you for supporting me in every way. Please know that I count you as a blessing in my life, whether you are family, a friend or just someone reading my blog. I hope that your Thanksgiving holiday is filled with an abundance of love and gratitude for a bounty of blessings!

Joy

Tamatave has been my home for over 2 weeks now, and I already know I will miss it when I leave. I can't say enough about what a beautiful city this is, and the fact that I am writing this on the beach with waves crashing at my feet is only reinforcing this. I really could go on, but I know it is neither the reason I am here nor the reason you are reading this post. Nonetheless, I will share a photo of the beach just minutes from where I live.

It may have been an administrative error or perhaps a misreading of my nervous smile, but I am now a charge nurse on my new ward! Finished orientation one day and in charge the next-- this is a common theme in the Mercy Ships realm. Somehow they must have forgotten about the episode where I dropped the supply room key down the squattie pottie and spent 15 minutes fishing it out, with many inquistive glances over my shoulder from curious patients. Maybe they just chalked it up to a lesson learned on the importance of securing objects to one's garments, as I now have a whole ring of keys that I am responsible for.

Amidst orientation and all the logistics that come along with a large organization, I have managed to spend some sweet time with our beautiful patients.  Looking at the radiant smiles of our OBF (obstetric fistula) women, you would never guess the trauma they have suffered physically and emotionally. 

For those of you who may be curious, I'll give a little background on fistulas. Poverty is a driving force in the formation of fistulas, as inadequate nutrition leads to a small (underweight/undernourished) stature of women and lack of education often leads to marrying young or being unaware of the science of life. These factors place women at a high risk for a difficult labor, and combined with the absolute lack of medical care, women may labor for days unassisted or with inadequate care. The extended, obstructed labor results in permanent damage to urinary, reproductive, nerve, and colorectal systems. The baby usually does not survive this traumatic event, leaving the women physically and emotionally bereft. This is only the beginning of a long road ahead as they are often pushed from society, unable to obtain work due to the stigma and symptoms of fistulas. 

It is hard to believe these women have traveled this road with so much dignity and grace. It seems that the journey could embitter and harden even the best of us. Yet our patients continue to lift joyful praise to God, regardless of their situation, outcome, or future. I believe these women are a testament to the book of Ecclesiastes, living the belief that God's timing and his plan are perfect, and there is nothing sweeter than surrendering to his plan. Ecclesiastes 3:11-13 "He has made everything beautiful in its time. Also, he has put eternity into man's heart, yet so that he cannot find out what God has done from the beginning to the end. I perceived that there is nothing better for them than to be joyful and to do good as long as they live; also that everyone should eat and drink and take pleasure in all his toil- this is God's gift to man." As a medical professional, I worry and fret over surgical wounds and outcomes. I often fail to see the plan for the 20 year old girl that will continue to pour out urine for the rest of her life, knowing there are thousands more in her situation, or for any of these women who have lost a child in this traumatic birth. Yet God has promised that it will be made beautiful in its time-- and that is timing I may never know or see. Knowing this promise, I can take joy in each tedious or heart wrenching task, knowing that it is all a part of His perfect plan. 

As I have postponed this post for awhile, there is now much to include from the past couple of weeks and I simply don't have the room to write it all. To summarize, I'll say that the food situation has been very good, with fresh coconut from the market and plentiful lychee on the ship. Daily views of the beach on morning runs are great motivation to exercise, even in the tropical climate. We have regular "uninvited visitors" at our apartment, and while this was not the wildlife I expected to see in Madagascar, I am learning to embrace these spontaneous visits. Ministry opportunities abound, with weekly visits to children's homes, a home for the elderly, handicap and deaf schools. The work of the local organizations is incredible, with meager resources used effectively to create a nurturing and caring environment. I also had the opportunity to visit a local church this Sunday, with an appropriately themed sermon on faith. The building was recently pieced together with tin and twigs, and a couple sticks of lumber, flapping about and creaking in the breeze. It remained erect throughout the service, and is surrounded by a solid cement building in the process of being built. 

Early morning view from our clinic after night shift 

One of our house pets

The requisite nail painting session at the home for the elderly 

Agape Church

A precarious shelter that echoes with beautiful songs of worship 

A glimpse into some of the many forms of transport here- our land rover, tuk-tuk, pous-pous, and motobike.

I think I'll leave the post here, with more to expound upon next time. I am so thankful for the opportunity to live here, to serve with the Malagasy crew, to work with volunteers from around the globe, and to know the patients we came here to serve. I can't help but miss my home in Dallas, proving the old adage that absence makes the heart grow fonder, but I am delighted to spend my time away here in Madagascar. Thank you for reading this, for your prayers and encouragement, and for support in every form. This ministry is definitely a team effort, and I am so happy to have many people helping from home. May each of you find equal and exceeding joy in all your toil!