Bookends

Two weeks ago I received the oft-dreaded notice of departure. This email has sent many a crew member into a whirlwind of emotions and I was no exception. One moment I wished I were immediately on the first plane home and the next I was devastated that I will be leaving Madagascar and the ship behind. Like the ship during sail, my emotions have felt tossed on the waves and I have felt unsteady on my feet.

I'm in a glass case of emotion

My attempts at collecting my thoughts and processing my feelings have been thwarted by the nature of ship time. In the thick of the field service, days seem to drag on and that departure date seems to stretch into the very distant future. But as my time on the ship comes to a close, a lifetime passes in a second and I feel as if I’m barreling toward my scheduled disembarkment. So here I am, the night before I take that long and winding 8 hour bus ride back to Tana for the last time and I have yet to fully grasp all that I’ve experienced and learned these past 15 weeks. I need some sort of therapeutic outlet for these thoughts… and my blog seems as good a place as any. Please bear with me while I wax poetic and forgive me if I start to ramble– although I probably already am.

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Encephaloceles

I had the privilege of being part of Mercy Ships’ history this past April.  During the Madagascar 2014-2015 field service (fondly named Mada 1), the screening team came across five unique patients with a very complex problem– they all had encephaloceles.

Encephloceles are caused by a failure of the neural tube to close completely during fetal development.  This defect presents as a sac-like structure that contains brain matter outside the skull.  The actual cause of this failure is unknown, but appears to be linked to decreased maternal folic acid intake (a common supplement found in prenatal vitamins).

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Obstetric Fistulas

Imagine you are a young Malagasy girl (this will probably be easier for the women reading).  You were married as a teenager and are now pregnant with your first child.  You are overjoyed to bring a new life in this world and grow your family.  It is time for the baby to be born, but something is wrong.  Whether it is your small pelvis, or the size of the baby, or any other number of pregnancy complications, the baby won’t come.  The contractions keep coming in wave after wave, and you pray that it will end.  You are having an obstructed labor and you require surgery– a simple C-section.

But here in Madagascar, surgery is anything but simple.  Your family manages to get you to the nearest hospital- which is a two day journey from your village.  When you arrive, the hospital tells you that they can not help you.  There are no surgeons that perform that surgery if there are even surgeons at all.  If you do manage to find a hospital that can perform a C-section, you and your family are sent across the street to the local pharmacy.  While the government pays the salary of hospital staff, you must buy everything required for the procedure– drapes, gloves, blades, suture, medications, IV tubing, sterile fluids, and anesthesia.  It comes to a total of $120 USD– a fortune that will push your family further into poverty.  So your choices are limited.  What you can’t afford, you go without or you don’t go through with the surgery.

You eventually birth the baby after over three days of labor and it is stillborn.  You are exhausted and crushed with the loss of your first child, but the pain is finally over.  You can start again.

Except you wake in the night and are horrified at what you find.  Your bed is soaked with urine… and as much as you try, you can’t control it.

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Mandibular & Maxillary Tumors

Only one more week left in Madagascar and moving on to tumors of the upper and lower jaws!  Thank you for the positive response to my post on cleft lips and palates.  I hope that you find this post just as informative and inspiring as the last one.

If I were to estimate, I would guess that about half of the total procedures we have performed in Max Fax surgery have had to do with removal of mandibular (lower jaw) and maxillary (upper jaw) tumors.

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Tumors are a type of lesion in which cells abnormally and rapidly grow.  They can be found in various areas of the body and originate from different types of cells.  One of the most common tumors that we have removed on board Mercy Ships has been ameloblastomas.  These are tumors that originate from the abnormal growth of tooth enamel.

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Cleft Lips & Palates

So the final countdown has begun– only 10 more days until I’m back home, only 2 more days of scheduled surgery.  And as I near the end of my first field service with Mercy Ships, I’ve found myself in the possession of an abundance of pictures and stories that I have yet to share.  Sure, I’ve shared my weekend excursions and adventures in town, but I’ve done more in the past 14 weeks than just that!  Sometimes I’m worried that this blog portrays my time in Madagascar as an exotic vacation rather than the amazing vocation it truly has been.

So for the next 4 blog posts, I will be describing briefly, and as simply as possible, different conditions that we have treated in our operating room aboard the Africa Mercy.  For the majority of my time here, I’ve been assigned to OR 3, which focuses on maxillofacial (Max Fax) surgeries.  Today, I will be sharing about a specific type of Max Fax surgery- cleft lips and palate repairs.

Cleft lips are openings in the upper lip that may extend to the nose and cleft palates are opening in the roof of the mouth that extend into the nasal cavity.

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Down by Andasibe

On Mother’s Day weekend, the Africa Mercy observed its last ship holiday for the Mada 2 field service.  For the extended three day weekend, I signed up for a two night stay at Andasibe (pronounced “Ahn-dah-see-bay”).  Early Friday morning, our group of nine women travelled south on the famous (and possibly infamous?) route between Tamatave and Tana.  The title of this post is a bit of a misnomer.  Although we were more south in the country, we were actually at a higher elevation; staying in the cooler rainforests of the mountains.

After nearly 5 hours on the road, we arrived to the Feon’ny Ala Hotel and settled into our bungalows.

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A Taste of Tamatave

As I near the end of my time in Madagascar, I realized that I had failed to share what Toamasina (or Tamatave as it is commonly called) is like. So in this post I’ll be sharing some of the sites and lifestyle I’ve experienced in town.

Alefa! (Let’s Go!)

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Fun Fact: Toamasina means “like salt” or “salty” in Malagasy.  Tamatave is the French translation of the same.

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