Simply Thankful

Happy Thanksgiving, sweet family & friends!

This morning a group of us gathered in the crew kitchen to throw together a few casseroles & bake a couple pies. It felt like a piece of home to be busy in the kitchen alongside people I love - peeling potatoes, singing Christmas songs, laughing at silly jokes and rolling out pie crusts. As I opened the oven to pull out the perfectly golden pies, the smell of warm cinnamon and pumpkin gave me a twinge of homesickness for the first time since my feet hit African soil back in August. 

Some days living across the globe on a ship feels a little crazy. Some days it just feels impossibly far from home, from so many of the people and places I love. On those days I do my best to take a minute to pause and remember why I'm here, to recalibrate my heart. I tripped across a picture of one of our orthopedic patients today, sweet little Dians. In an instant my heart filled with gratefulness as my eyes filled with tears.

I mean, just look at this face.

It's incredible to think about the transformation that's happening in her life, even as I sit on my bunk typing away. Multiply that by hundreds of other beautiful people, and it's nothing short of overwhelming. I'm so thankful to be here in Madagascar witnessing God's redemptive work in the lives of so many, including my own. I'm so thankful for His unwavering goodness in my life & in this world. Know that I'm grateful for each and every one of you too - for your support, for playing a part in giving me roots and wings.

I'm wishing you all the happiest of Thanksgivings. 

May God give you the eyes to see His goodness & grace in your life, today and always.

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"O My God, Thou fairest, greatest, first of all objects,

      my heart admires, adores, loves thee,

  for my little vessel is as full as it can be,

  and I would pour out all that fullness before thee

    in ceaseless flow.

When I think upon and converse with thee

  ten thousand delightful thoughts spring up,

  ten thousand sources of pleasure are unsealed,

  ten thousand refreshing joys spread over my heart,

  crowding into every moment of happiness.

I bless thee for the soul thou hast created,

  for adorning it, sanctifying it,

    though it is fixed in barren soil;

  for the body thou hast given me,

  for preserving its strength and vigour,

  for providing senses to enjoy delights,

  for the ease and freedom of my limbs,

  for hands, eyes, ears that do thy bidding;

  for thy royal bounty providing my daily support,

  for a full table and overflowing cup,

  for appetite, taste, sweetness,

  for social joys of relatives and friends,

  for ability to serve others,

  for a heart that feels sorrows and necessities,

  for a mind to care for my fellow-men,

  for opportunities of spreading happiness around,

  for loved ones in the joys of heaven,

  for my own expectation of seeing thee clearly.

I love thee above the powers of language

    to express,

  for what thou art to thy creatures.

Increase my love, O my God, through time

    and eternity."

- Valley of Vision (Book of Puritan Prayers)

Madagascar: the country that's poor but not poor enough for aid

"Madagascar rarely features on anyone’s list of urgent global causes. Its quiet desperation falls into that forgotten category of poor-but not-quite-poor-enough, perpetually hovering just above the red zone that triggers a glut of aid, NGOs and cameras. It cannot claim the f-word for famine, only severe food insecurity and, as an island of little strategic importance on the world stage, it remains better known for its lemurs."

Link to full article from The Guardian HERE

Vignettes

Happy November, friends! Goodness, how time is flying. The past few weeks have been chock-full of so many amazing new experiences. Each one really warrants its own blog post, but for the sake of getting the info to the people, I thought I'd write a few vignettes to give you a glimpse into what life has been like here on the Africa Mercy.

{Screening}

A few weeks back, I had the opportunity to help out in screening. As I'm sure you can imagine, there is a great deal of work that happens before patients walk up the gangway for their surgeries. The screening team is in charge of selecting individuals who qualify for the services offered by the ship. After their initial round of assessments, there is a second round where the surgeons see each individual and make the final decision to go forward with surgery or not. Thousands upon thousands of individuals wait in long lines in cities around the country, simply wanting a chance to be seen & hoping beyond all hope that someone can help.

The screening day I was able to take part in was a small surgeon screening for gynecologic issues here in Tamatave. We saw 15 women who all came with obstetric fistulas. Vesicovaginal fistulas are a major problem in the developing world. In brief, when women suffer from prolonged labor and are unable to access adequate resources for timely cesarean section when indicated, the baby's head in the pelvis causes a breakdown of tissue, which generally causes a fistula (or hole) in the bladder wall (if you're interested in reading more about it, click here). Sadly, with prolonged childbirth the baby usually dies in the process. It's absolutely horrific. And that's not all, because of these fistulas, these women constantly leak urine and smell dirty. More often than not, they are ostracized from society and from their families. It's not uncommon for these women to be left by their husbands because of the disgrace of their medical problems. Clearly, these obstetric fistulas involve more than just physical pain - the women suffer from so much emotionally and mentally as well. I could go on & on about the plight of these amazing women.

Anyways, back to screening... We did an assessment on each woman: gathering her story, vital signs, labs & assessment. Then each individual went through a separate assessment by the surgeon. It was fast paced and super interesting. Hearing these ladies tell their stories absolutely rocked my world - so much heartbreak and so much strength. We were able to send 13 ladies on to surgery! We penciled them in on the surgery schedule and handed them their iconic yellow appointment cards. What a beautiful thing it was to see their faces fill with hope and joy as I shared the news. One woman stood up and danced around, giggling like a little girl. All were so very grateful and excited. It was absolutely beautiful to watch this all take place.

But then there were the two we had to say no to. Oh, it was so hard. They came with so much hope for a life-changing intervention only to hear a, "So sorry, but we cannot help you." One woman had advanced cervical cancer - it would have been unethical to operate when she has no access to follow-up care for chemotherapy or radiation. The other woman was severely anemic and needed iron supplementation before being healthy enough to undergo surgery. Even in the difficult "No's" I saw these women treated with so much dignity. They were told the truth and spared an intervention that would be harmful (many surgeons here perform unethical operations for the pay out). Not only that, but life was spoken over them. We did not give them a number on their days with a well-educated guess. We simply celebrated them and the life they still get to live, trusting the God who alone knows the number on our days.

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{Dress Ceremony}





Just a few days after my day with OBF screening, I was able to attend one of the Mercy Ships dress ceremonies. These ceremonies are held twice a month to celebrate our post-op obstetric fistula patients who are able to be discharged DRY! After years and year of leaking urine they are finally able to have control over their bladders again. Many will have a second chance at motherhood and a normal life. For these women, being dry is a miracle. Each woman gets a new dress and hat, which is a huge deal. Before their surgeries they were not able to have nice clothes as they were constantly being soiled. At these dress ceremonies they are all dolled up with fresh hair & make-up and their new outfits - they are presented as restored women and it's breathtaking. You can just see the joy & radiance on their faces. Each woman gets a chance to tell her story in front of the crowd... The tears just continued to roll as these ladies bravely stood and spoke of their physical and spiritual healing. Some women had suffered from this condition for over 20 years. Can you imagine? Before they left, we all gathered to pray over them. The ceremony ends with dancing and music, rejoicing over the mercy and goodness of our God.

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{Orthopedic Evaluation Day}





A couple weeks ago, I had the opportunity to be part of a small team for orthopedics evaluation from last years field service in Madagascar. All the patients that were treated in the 2014 orthopedic outreach were invited to come back to the ship for a follow up evaluation. We saw about 30 patients and it was incredible to see their transformations first-hand. Before they were seen by the surgeon and physical therapy team, we sat down with each patient and their parents to go through an evaluation questionnaire. Here's a few examples of the questions we asked:
How satisfied are you with the results of your procedure?
How much shame did you experience before your surgery? What about after?
How accepted did you feel by society before your surgery? What about after?
If you had never had surgery, what do you think the likelihood is that you would get married? What about now, after surgery?
How much of a role do you think Jesus had in your care and healing?

It was so fun to hear their responses to these questions - I swear I was hanging captive to their every word. What incredible testaments to God's redemptive work in their bodies and souls! By the end of the day I just wanted to stand on my chair and shout, "People! People! This is worth it! All of this is SO worth it!"

Thus says the Lord God to these bones: Behold, I will cause breath to enter you, and you shall live. And I will lay sinews upon you, and will cause flesh to come upon you, and cover you with skin, and put breath in you, and you shall live, and you shall know that I am the Lord. - Ezekiel 37:5-6

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{A Ward Updates}



These sweet plastic surgery patients are all discharged and healing well. We miss their sweet faces (I mean, just look at those faces), but are thrilled that they are doing so well! A-ward is now in full swing with orthopedics, which has been a fun change. All I can say is that little kids with little walkers get me every stinking time... so cute! Check out this short video below for a peak into the orthopedic world on the ship.

I've started working as a charge nurse on the ward, which has been challenging but good. It's really not that much different from working as a charge nurse at home - just a bit of a learning curve getting used to the Mercy Ships way of doing things. 

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{Data Entry}

A few weeks back, I was assigned to data entry for the day. I was given the assignment of entering patient demographic data into our computer database:
Married or single? 
Do you have kids? How many? Any deceased?
Where do you get water from?
What type of bathroom facilities do you have?
What amenities do you own?
How much education have you had?
Are you able to read?
What is your floor made of?
What type of access do you have to medical care?
What were your biggest barriers to receiving surgery?

As an example, this is just one that I quickly jotted down:
34 years old. Female. 6 pregnancies. 6 deceased children. Single. Water source: river. Bathroom facilities: pit latrine. No education. Unable to read. Floor made of dirt. Insufficient funds to have surgery.

As I input an entire stack of these forms, I realized how easy it is to get lost in the numbers. I tried my best to focus on each one as if they were sitting in front of me - treating it as a little snapshot into their lives. It was sobering, to say the least. My heart just broke as I wrestled with the realities of their lives. Here on the ship sometimes it's easy to separate yourself from those realities - they are here on our turf after all. But their lives, all of them, are hard. All of them have been burdened by disease and poverty and heartache. Sometimes the weight of it all feels like it could crush me. My bunkmate, who is just a gem, is quick to remind me of a quote by Dr. Gary Parker, one of the long-term surgeons on the ship... "We cannot change the whole world, but we can change the whole world for one person.. Then the next... Then the next." When the burden & heartache threatens to crush, this perspective is one that has kept me going. My day in data entry was humbling and difficult, but I certainly came out of it with new eyes.

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{Mercy Ministries}

On our days off we have the chance to volunteer with local ministries in the city ("Mercy Ministries"). It's a fun way to get off the ship and experience local culture. I've had the chance to go to a local deaf school and to a local orphanage so far. The pictures above are from one of the days at the orphanage.

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{Blood Donation}



In order for this to be a fully functional surgical ship, the volunteers are called upon to serve as the on-call blood bank. A few weeks ago, I got the call that it was my turn. I've donated blood at home before, but it was really fun to know that the blood that was running through my veins was going down the hall to a patient in need. A maxillofacial patient that I know and love. The Malagasy people have a proverb, "To give blood is to give life." I think that's really beautiful. It may just be the nurse in me, but there really is something important and symbolic about blood. Jesus' blood was shed for us in a perfect act of sacrifice. Though it's small in comparison, I think that donating blood can be a beautiful act of worship... a reflection of being poured out in love.

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{Full-Time Nurse, Part-Time Barista}

I think I may have mentioned this before, but there is a Starbucks onboard the ship. We are lucky enough to have the cheapest Starbucks around... only $ 0.75 for a latte. Starbucks donates all the equipment, coffee & syrups to keep our little cafe buzzing. There are a handful of full-time cafe staff, but they also utilize other crew members on the ship. My friend Lindsey and I decided it would be a fun new adventure, so we signed up for the training a few weeks back. I'm scheduled for a few shifts in the coming weeks and am hoping to perfect my latte skills.

Bonus points for anyone who actually made it to this point. This was a long blog post & long over due. My sincerest gratitude for all your support & prayer. Know that it's the lifeblood behind the work being done here. We could not do this without you!

Sending love across the ocean,
Jarah

Broken Bodies // Eternal Souls

At two months in, the novelty of this place is starting to wear off a little. What was once difficult and and uncomfortable has now become quite comfortable and commonplace. I'm in a bit more of a stride with my role as a nurse on the wards and in all areas of life, really. For the most part I have my people and my places and my routines. It's certainly been an adventure with its own unique set of challenges, but I'm loving it here more than I can convey. It has been nothing short of life changing to watch miracle after miracle unfold on the wards. Much transformation takes place through the work of skilled human hands, but make no mistake, it's all God's doing.

There are hundreds of stories and snippets floating around in my mind, but for some reason I've had a difficult time getting them down into words. Sometimes I question, who am I to tell these patients' stories? How can I possibly pen their experiences accurately? Surely there is so much more than I'm privy to in my limited observations and translated conversations. I fear the danger of presenting them simply as a before and after picture - they are so much more than that! They are beautiful people with their own stories and families and hopes and dreams and futures. They are not just a tumor or a broken body, they are people worth knowing. They have as much to offer me as I have to offer them. I've really struggled with my place in posting pictures and status updates, or even writing full patient stories here on the blog. I desperately don't want to be that girl who came to Africa to collect stories & photos that make me look like the brave, selfless hero. I am none of those things.

With everything in me I want to avoid fueling the white savior complex of our age. Billions of people in our world lack access to safe surgical care - yes, billions. I've been gifted with a medical education that can be used to help, but to be clear, I am not the savior here. To be candid, it's easy to desire to be. It's easy to want to rush in and fix something, and feel like from that point on everything is going to be good for the people you've come to help. We all want to see the nicely packaged story with the happy ending, but it's always more difficult and complex to do good than we imagine.

The larger reality is this: though we are taking part in incredible, redemptive work - fixing what's been broken, removing disfiguring tumors, releasing burn contractures, mending bones, correcting cleft lips, and repairing vesicovaginal fistulas - the health and vitality we see in all of these patients will eventually fail. These patients are all going to die.  It may be next week and it may be 50 years from now. God only knows the number on our days. Whether through old age or disease or accident, their bodies are not completely restored. They are very much mortal and very much part of this fallen world. Yes, their lives have been dramatically changed by these surgeries, but one day they will die and come face to face with their Maker, just like we all will. I fear that this is sounding overly morbid here, but I think it's a reality that's important to come to terms with. And, if we're honest, this begs the question: If we're only mending broken bodies and not impacting the eternal soul, then what are we doing? 

As Jesus followers, how we combine social justice/humanitarian aid with evangelism is an ever-evolving discussion, and it's not one I intend to unpack here on the blog. I do think there is a lot to be said for pressing into the tension and seeking to love holistically, fully recognizing that people are both spiritual and physical beings (Goodness, I said I wasn't going to get into this...).

As I've been wrestling through this in my own heart over the past few weeks, God's been gently reminding me of so many important truths. First, He loves these people more than I ever could and has been at work here long before I even entered this world. Second, I am called to speak truth & life as I help mend broken bodies, but the world is not actually mine to save, it's His.
And He is a very capable Savior. 

In all our efforts to impact bodies and souls, may we learn to trust His loving & capable hands.

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“Salvation belongs to our God who sits on the throne, and to the Lamb!” - Revelation 7:10

"We serve others not with some hidden scheme of making converts, rather to contribute to the common good, to help humans flourish as God intended." - Philip Yancey

"The main principles seem to be to love people, build relationships and out of that share your faith. We ask that people remember that our patients are vulnerable and as such no coercion should be used. We are not here to count how many 'come to Jesus' but to be like Jesus, to love them and let God do the accounting for us." - Anonymous Mercy Ships Volunteer

"The desire to save, whether from sin or poverty or exploitation, is one of the most damaging motives in ministry. Humility is the real Christian virtue…when we come to realize that…only God saves, then we are free to serve, then we can live truly humble lives. It makes all the difference in the world whether I view my neighbor as a potential convert or as someone whom God already loves."
- Henri Nouwen

"What you do in the present—by painting, preaching, singing, sewing, praying, teaching, building hospitals, digging wells, campaigning for justice, writing poems, caring for the needy, loving your neighbor as yourself—will last into God’s future. These activities are not simply ways of making the present life a little less beastly, a little more bearable, until the day when we leave it behind altogether. They are part of what we may call building for God’s kingdom." - N.T. Wright

"A path forward is found, not through providing resources to the poor, but instead by walking with them in humble relationships."
- Steve Corbett (When Helping Hurts)

"The more perfectly we know God the more we will feel the desire to translate the new-found knowledge into deeds of mercy toward suffering humanity." - A.W. Tozer

"Go out into the world uncorrupted, a breath of fresh air in this squalid and polluted society. Provide people with a glimpse of good living and of the living God." - Philippians 2:15 (Message)

"My flesh and my heart may fail, but God is the strength of my heart and my portion forever."
- Psalm 73:26

Scars

I couldn’t help but notice her reaching for that small hand mirror, taking a look from every angle, lingering long. I could tell something was on her mind so I walked over and asked if everything was alright.

“My nose. I thought the doctors were going to fix my nose. And what about these scars on my face? Will they ever go away?”

For nearly a week, the history behind her burn contractures was a complete mystery. We all attributed it to an accident, likely related to her underlying seizure disorder. That would make sense. During a dressing change last week she bravely voiced her story – a story that will never make sense. She was sitting on the side of the road in the capital city, selling fruits and vegetables like she did every other day, when a car sped past pausing just long enough for a man to jump out and throw acid in her face. She was an innocent victim of a senseless crime. Instantly feeling blinded, suffocated and aflame, she ran around in utter panic while nearby street vendors did their best to clean her up and calm her down. Her memory is somewhat fuzzy on the remaining events of that day, but she remembers waking from the brutality to find her face and neck completely covered with severe chemical burns. Lacking access to adequate medical care, she miraculously recovered, though the resulting contractures significantly restricted her mobility and function (read more about burn contractures here).

This woman came to the ship unable to turn her head, chew a mouthful of food or fully blink her eyes. The plastic surgeon performed an extensive operation involving skin grafts, an eyelid revision, and multiple z-plastys. Her recovery has been long and hard, wrought with pain and infection and fear of graft failure. Though she is still in the early phases of her recovery, she is doing remarkably well. She is already able to close her eyes, chew her food, and turn her head to the right and to the left! Can you imagine?

Even still, those scars…

I know she is rejoicing over the huge progress that’s been made, but things are not as they once were. Even with this surgical intervention, she will always see the marks of that trauma when she looks in the mirror. As I sat across from her, it was plain to see that those scars went much deeper than any third degree burn ever could. There are wounds inside her that I cannot reach. There are wounds in so many of our patients that I can't reach and it breaks my heart to see them carrying such huge burdens. I'm learning, though, that I can speak life & hope over them in this place.

“Those scars may fade a bit with time, unfortunately we cannot make them go away. But look at those scars, they show that you are strong & that you survived! And now you can move again in ways you haven’t been able to in years! You are not your nose. You are not your scars. You are a precious, loved child of God. You are of infinite worth, your life has so much value."

Ever so slowly, this amazing woman has come out of her shell. Her eyes are shining brightly & you can see new joy growing. I pray that in this journey she will continue to see her scars through new eyes. I pray that she will know how loved and cherished she is.

                                                                                                                                                                                                               

In just a matter of weeks, the first round of plastic surgeries for this field service is complete. We are still caring for many of these sweet patients on A-Ward - praying for tissue growth, protecting from infection, providing extra protein to expedite healing, checking neurovascular signs every 4 hours, and standing in awe at miraculous improvements with each dressing change. These patients have been with us for weeks and I'm quite certain each and every one of them has stolen a piece of my heart. As they are slowly beginning to be discharged home I'm rejoicing with them over fingers that move, arms that raise, necks that turn, eyes that close, feet that stand, and elbows that bend. They are survivors! My hope and my prayer is that they would go back to their homes with stories of restoration. I pray that when asked about their scars, these patients will proudly speak of released contractures, restored self-worth, and how the love of Jesus has given them hope.

Jesus was also an innocent victim of cruel, senseless torture. He hung on a gallows and died a criminal's death. He too bears the mark of His suffering with scarred hands, feet & brow. He has entered into the pain of this life. And by His wounds He made it possible that you and I may be healed! May we all learn to see our scars in light of His.

He heals the brokenhearted and binds up their wounds - Psalm 147:3

 (Raise the roof for this axillary release!)

“... I ask you right here please to agree with me that a scar is never ugly. That is what the scar makers want us to think. But you and I, we must make an agreement to defy them. We must see all scars as beauty. Okay? This will be our secret. Because take it from me, a scar does not form on the dying. A scar means, I survived.” 

- Chris Cleave (from Little Bee)

Surgery + Global Poverty

One of the most critical needs facing the developing world is a lack of access to safe surgery. It's been incredible to see how an organization like Mercy Ships is seeking to make a dent in this sizable need. In fact, the New York Times just featured an article on this issue & highlighted some of the work being done by Mercy Ships. This excerpt below was really interesting (thought I'd share):

"Every year over 80 million people worldwide face financial catastrophe if they get surgery. And while the individual cost of getting surgery is great, the societal cost of inaction is staggering. If nothing is done to increase surgical access, developing nations are projected to lose $12.3 trillion from their gross domestic products between now and 2030.
Currently, infectious disease interventions are the main focus of global health policies, because many countries lack the personnel and infrastructure to carry out surgical interventions successfully.
Despite the fact that nearly one-third of human disease is amenable to surgery, it remains overlooked in much of the world."

To link to the full article, click here

Look Full In His Wonderful Face

I walked into the maxillofacial ward for the very first time - one look around the room and I quickly swallowed a rush of fear. This ward is home to patients that present with some of the most dramatic deformities and illnesses, all from the neck up. I grabbed my clipboard and gathered with the rest of the nurses for the change of shift safety briefing & prayer. As we all circled up to pray over the evening shift, I quietly whispered, "Oh Jesus, help me. This is going to be hard."

During handoff I looked up and saw him lying there, back turned, face tucked beneath a blanket, making every attempt to be invisible. That's the thing I'm learning about so many of these patients, the hostility of this world often pushes them to hide. They come to us veiled, both physically and emotionally. As I approached his bedside, the smell of gangrenous flesh was almost too much to handle. I peered over the blanket and saw a softball sized tumor standing out from his lower jaw. His gaze met mine. Instead of greeting him with a warm smile, my eyes quickly darted away and I nervously scribbled something down on my clipboard. I couldn't look, but I also couldn't quite look away.

I went about my tasks at the beginning of the shift, attending to each of my patients. When I finally made my way back to his bedside, I heard that still small voice say, "Jarah, this is my beloved child. You will look him in the eye and show him the utmost dignity. You will engage with him and show Him my love." I put my hand on his shoulder, and he turned around to face me. I felt awkward and uncomfortable, but somehow managed to look him in the eye and say, "Hi G-, My name is Jarah. I'm going to be your nurse tonight and I just wanted you to know I'm so glad you're here." A small smile came across his face and he slowly rolled back.

Throughout the shift, the two of us had more and more time to talk. I asked about his life and did my best to see past his tumor. I'm learning how vital it is to push past my own discomfort in an effort to really see people who have gone unseen for so long. Eye contact is so powerful, sometimes holding our gaze communicates love more loudly than anything. The longer I looked at him, really looked into his brown, soulful eyes, the more I saw Jesus there. And with that my heart just ached for him to be healed and whole.

Though I only took care of this brave soul on one shift, I've been following his progress quite closely. I'm happy to report that his healing is well under way! Physically, he is still waiting for surgery as the medical team works to correct long-standing malnutrition and infection. So many of my peers have continued to shower him with love and acceptance. Emotionally, he's started to see his own worthiness again and is no longer hiding. During recreation time on deck 7 he can often be found initiating a game of Jenga or playing sports with other patients. It's truly been beautiful to watch his transformation take place.

As I've been processing this all week, the words from that old hymn have been playing through my mind: "Turn your eyes upon Jesus, look full in His wonderful face, and the things of earth will grow strangely dim, in the light of His glory and grace." Friends, I'm learning to look full. To hold a gaze in the face of Christ & his beloved children. What great beauty there is to be found.

This is Sambany. He was treated during last year's field service in Madagascar - what a remarkable change! I thought I would post his picture here as an example of the patients we see in the Maxillofacial unit. More pictures from this year coming soon!


“I think that every human being has the right to look human. To be treated as human. To have a place at the table of the human race. And when you have been deprived that seat, and it’s offered to you again... to be able to re-enter the human race and to look like everyone else... that’s a fantastic thing.”
- Dr. Gary Parker