April 27, 2010

My stomach does flips when I think about writing this story. I have been hesitant to tell it through type, knowing that much is lost when experience turns to storytelling turns to blogging. But I want to tell it, as much for your knowing as for my own internal equilibrium. Here it goes:

A growing Catholic parish on the east side of Lome has nearly completed construction of their new church, a majestic cathedral. It lacks only some wall panels and exterior fixes, but already the priests celebrate Mass inside. It dwarfs the old church standing 30 feet to the side, a single story, cinderblock building with little fanfare. Inside this humble structure, Saint Charbel, Saint Faustina and their comrades stare out of sandy picture frames. Two wobbly candelabras and a tabernacle indicate that the space is still used for silent prayer and Adoration. It is also the space where we hold our Friday clinics.

Despite our being exclusively an eye clinic, myriad medical conditions–from hernias to Parkinson’s to goiters to elephantiasis–find their way through our doors. Mercy Ships specializes in a tiny slice of this broad spectrum, so often I must say that there is nothing we can do to help. If it does match up to one of Mercy Ships’ programs, I try just as quickly to triage to the correct screening site.

Back in February, our first ever Friday clinic has just begun. The hundreds upon hundreds outside are pushed up against the front doors and the front of the building in a wall of angry flesh. Inside, I am arranging the visual acuity stations and worrying about the mess outside. One translator approaches me, a man and a woman trailing him. Somehow, they have slipped through the masses and sneaked in through a back door. “V.V.F.,” he says, short for vesicovaginal fistula, or a hole in the vaginal wall. Aha! We have a program for that! I think to myself. Pull out the clinic listing, point to the correct (i.e. not eye) clinic and move ’em on out. Easy.

Several minutes later, our ophthalmologist Liz pulls me to the side. It is the urgency in her voice that yanks me out of my logistics bubble and into the gravity of the situation at hand. Apparently aware that they were being shooed away, the pair has interrupted Liz’s eye exams to try for help a second time. “Alana, this is a V.V.F. woman,” she says.

Women with V.V.F. are not ordinary patients. Medically, they are no better or worse off than the other patients we help. In every other way, they suffer greatly. When a hole is created between the bladder and the vaginal wall, urine leaks out incessantly. You can imagine the smell, the fluid dripping down their legs, the trail of waste. Husbands leave them. Villages reject them. They often live in the countryside, utterly alone. They have been thrown away. The world has declared them less than human.

Liz leads the pair to a quiet corner, just in front of the church’s tabernacle. I phone the hospital and eventually get some contact info for the nurse coordinating the V.V.F. program. I walk back to the corner where the two people sit quietly. The woman does not raise her eyes to meet mine, leaving the man to answer all of the translator’s questions.

“Does she have children?”


“Has she been deserted?”


“Was she cut?”


Liz fears the worst. That she has been genitally mutilated. That the procedure was botched, leaving a fistula in its stead. The man at her side is a pastor and has taken pity on her.

The stench of urine sits heavy. Lord, my heart is not big enough to hold onto such sorrow! Here she sits, and I glance up, and there in front of us is the Blessed Sacrament. Christ in the flesh in a piece of bread, and Christ in the flesh right in front of me, hunched over on a bench. For once it is so clear, this presence of God in the weakest among us. I feel the immediate obligation to love, for what other response is there? But for no good reason I waste ten or fifteen seconds silently hemming and hawwing about whether my action will offend her, or frighten her, or appear insincere. And then I muster up some courage: I rest my hand on her arm, and she looks up briefly, and I smile at her, because she speaks some tribal language and I do not. The best I can give is not grandiose but very small.

The man tells us that she hardly has enough money to return home. She has traveled 150 kilometers to see us. Liz and I dig into the deep pits of our pockets and bags, a futile search for coins. It is silly to bring money to a place like our clinics. Someone finds a US $1 bill. Liz tucks it into the woman’s hand, and she appears stunned at the gift. I walk the two to the door, say goodbye, watch the woman shuffle down the steps. I promise her that we want to help her, promise that we will call the phone number she wrote down, which cannot possibly be hers, since she has no money.

Back at the ship, I sit down with the V.V.F. coordinator. I hand her a copy of the woman’s contact details; the original paper is zipped in a plastic bag with other treasured scraps that I would hate to lose. We talk about the woman, about what happened to her, about helping her. I learn that the organization which funds the V.V.F. program has set limitations. Only certain fistulas will be considered for operation on the ship.

The target population is poor women who live in remote areas–women who have no prenatal care, women who labor for days and days in their huts. The constant pressure from the baby pushing down creates a hole. But you see, vaginal fistulas can also be caused by hysterectomies and other gynecological/obstetric surgeries. The knife slips, opening a hole, unnoticed by the surgeon. The funding organization does not want this second group of women–who could obviously afford surgery in the first place–to be included in the pool of candidates for surgery on the ship. Only women who have fistulas caused by obstructed childbirth will be considered. And no, that does not include genital mutilation. My heart hurts. The V.V.F. coordinator will email, will see if we can squeeze the unexpected into the tightly woven mesh of grant money. I wish the person sitting in an office across the oceans knew that we would meet this woman.

I memorize her name and age to ensure that I won’t forget her. She makes her way into my prayers often. My mother and father ask about her during each phone call. After good days, when I am finally alone in my room and my heart has the space to be heard, I weep for her. There is grief everyday at the eye clinics, so many helpless cases, but it is this woman who has irreversibly stitched herself into my heart.

A month and a half passes. The email has finally come. The answer is no. No, we cannot operate on a fistula caused by genital mutilation. No, an extra donation will not help. No, she cannot be fit into the program’s structure. No.

But this woman, she is waiting! She is hoping! We should call her, try to get a more thorough medical history. The V.V.F. coordinator agrees. Her heart aches too, I am sure.

The next day, the quest begins. This woman lives in northern Benin and speaks Adja. There is only one translator I find who speaks Adja–and it is our own beloved Pierre! We take a break during the clinic that morning to phone the contact number. The woman is not there, a man’s voice says. She works out in the fields all day long, and will be back near the phone at 4 pm.

We return to the ship at 1, and Pierre insists on staying so that we can call her together. He waits in the heat, on the dock, for three hours. If we can save her life, he says, it is worth anything.

We phone at 4. And at 4:10. And 4:15 and 4:17 and 4:20 and 4:30. And the next day. She is never there, always in the fields. After multiple days of attempts, the man at the phone says that he will bring her to Togo. If there is any chance, he says, it is worth it. “Do not come to the ship!” We say. “We just need to ask her some questions.”

But he is stubborn, as all true friends are. The very next day, as I peruse the markets downtown, my phone rings. Not only have the man and the woman come to Lome, but they are waiting for us on the dock! Head spinning, we jump in a taxi to head home. I call Pierre, and he drops everything to make his way to the port. “But I told them not to come!” I think to myself.

The twenty-minute drive has never felt longer, but finally we arrive at the gates, pay the driver, and make our way through the semis and containers towards the ship. And there she is! Even from a distance it is apparent that she sits a bit taller, looks up instead of down. Her dress and head scarf are blue with bright orange flowers, and look freshly pressed: she has come wearing her best (or maybe a neighbor’s best). She carries only a plastic bag, filled with belongings for the journey. What joy to see her again–but also dread. I fear that the news we have for her will be bad–news that what she so desperately wants we cannot give. It would have been easier to tell her this over the phone.

I page Maggie, the V.V.F. coordinator, tell her I’m sorry to pull her out of bed when she is on night shift, but that our very special woman is waiting at the bottom of the gangway. She and I are equally overwhelmed that they are here in Lome, and that they somehow bypassed two points of port security.

The medical history begins, and this time in earnest. Have you ever been pregnant? Yes. How many times? Once. What happened? They cut my tummy to get the baby out. (She draws a line from her naval down.) Was it a doctor who cut you? Yes. How long were you in labor? One day.

So she was not mutilated–Praise the Lord! But then, just as quickly as I have hope, it evaporates. She has had a c-section. She only labored for one day. She was cared for at a hospital, by a real doctor.

But she has traveled far to be here–nine hours, in fact–so we will hold onto an iota of hope and continue the questions. Do you leak urine constantly? Yes. Is the bed wet when you wake up in the morning? Yes. How long have you been leaking? Eight years. How long were you in labor? One day. Did the baby die? Yes.

One day, and then a c-section. With each detail, the hope for fistula surgery fades.

And then, unprompted and for whatever reason, Pierre adds another bit of information. A bit that the woman told him before I arrived, something that has not seemed worth mentioning, but Pierre figures might be of slight interest: “She was also in labor for five days before she went to the hospital.”

With tears in my eyes and a huge smile, I turn to Maggie–FIVE DAYS!!! That’s the golden ticket!! Her fistula did result from obstructed labor!

Never have my spirits soared so high to hear such terrible news!


The evening ends joyously. Lauren and I bring out plates of tuna and sausages and french fries from the dining room, and we all sit quietly on the dock and watch the sky fade from cobalt to indigo. The woman sits on the ground and props her plate on her knees. A sea breeze rolls in, replacing the day’s sweltering humidity. Serenity.

A Mercy Ships car arrives to bring the woman and the man to our hospitality center. They can stay the night there before their long journey home. Maggie gives her a plastic bedsheet and four adult diapers: two for tomorrow, and two for next month. She has an appointment to return to the ship, when the V.V.F. surgeon will be here to examine all the women.

The night glows in a brilliant array of stars. The car door closes, and I wave goodbye to my beautiful Jesus.

We will call her Kpely. Please join me in praying for Kpely. Pray for her journey to Togo in May. Pray that her fistula is operable. Pray that she has the chance to once again feel human.


A belated introduction

April 25, 2010

Welcome to the Eye Field Team! We’ve undergone many iterations over the past few months, but here’s the (almost) current version:

Bottom row, left to right: Isaac, Queen, Edith, Nutifafa, Komla, Pierre. Top row: Alana, Tchecre, Joel, Jean Claude, Lauren

Our eight translators hail from different parts of Togo, and Pierre comes from Benin. Three are pastors (Jean Claude, Pierre, Komla), one is in school for marketing (Nutifafa), another dreams of being a farmer (Tchecre), and one is just 18 years old (Edith). Together they are the backbone of the clinics.

The two crew members in the field are Joel and me. Joel is a 24-year old Irish optometrist. He drove from Ireland to Togo in a VW bus. Yes, you read that correctly!

Lauren, our medical reviewer/scheduler and a dear friend, went home to Florida yesterday to begin her Master’s in PA (Physician Assistant) studies. She is missed already.

Stay tuned for more tales from the field.

I hope you can’t help but smile =)


April 10, 2010

“Sarah George. Report to the lab.” Sarah makes her way to deck 3, where our resident vampires, Linda and Naomi, wait, needles in hand. Naomi plunges a 14 gauge into Sarah’s vein, and the plastic sac begins to fill with bright red blood. It’s 8 pm on a Sunday night–not usual working hours for a blood donation center, but on the Africa Mercy, anytime is fair game.

In countries like Togo, where diseases like hepatitis and HIV run rampant, the general population is not a reliable source for clean blood donations. So, who do you turn to? Answer: The crew!

The blood donation system on this ship fascinates me. In developed countries, the usual sequence goes: Draw blood from donor. Separate into component parts. Send to hospitals. Refrigerate red cells for up to 35 days. Distribute as needed. On the ship, the order goes more like this: Draw blood from donor. Carry into the OR. Transfuse into patient.

This hospital is one of the few places in the world where transfusions of whole blood still take place. The centrifuges needed to separate blood into its component parts–red cells, plasma, platelets, etc.–are too bulky and expensive to house on the ship. Same goes for the refrigerators needed to store blood. As a result, everything happens in real time. The doctors identify patients who might require blood before, during, or after surgery. Our lab techs match up a string of pre-screened donors who have the same blood type, then notify each that they may be called in, whether that be in the morning, afternoon, or the middle of the of night. If a transfusion looks imminent, donors are asked to refrain from leaving the ship.

I’m not one for needles, so Sarah allowed me to experience vicariously the joy of giving blood. I sat with her as Naomi poked and prodded, helped her off the bed, and took one for the team by finishing off some cookies afterwards. Sugar aside, the best part was our trip to the ward the next day. Sarah approached bed 14, where a young woman propped herself up on a pillow. A line of stitches snaked from her temple to the bridge of her nose, down her cheek, then disappeared under a blue rag she held over her mouth. Two days earlier, doctors had removed an enormous tumor from her lower jaw. Sarah laid her hands on the woman’s legs. She introduced herself, and a translator spoke to the woman in Ewe: “This is the girl who gave you blood!” With a patched up face and a mouth still silent from swelling, the woman lifted her arm up and down, up and down, saying “Thank you!” in a most beautiful way.


April 4, 2010

“Once Christ is risen, the gravitational pull of love is stronger than that of hatred; the force of gravity of life is stronger than that of death… The Lord’s saving hand holds us up, and thus we can already sing the song of the saved, the new song of the risen ones: Alleluia!”   -Pope Benedict XVI

Have a joyful Easter!

Bob, Lauren and I arrive at the church around 7:45, and we are heartily greeted by our nine translators. Circle up for prayer. Sometimes it is in English, sometimes in French, sometimes in Yaruba. As the others unload boxes of sunglasses, medicines, charts, and other odds and ends from the back of the truck, I take a casual walk outside to survey the crowd. The people organize themselves differently at each location, and even within one site it can change drastically from week to week. Every morning is a new puzzle.

West Africans have yet to understand the concept of a “line.” Instead, they assemble into clumps and lumps and amorphous masses. At our most organized cinic, I gaze at the expanse of people in front of me and can usually recognize the divisions: Children with their mothers to the far right, elderly adults to the far left, men and women in separate blobs squished in the middle. Each group bleeds into the next. The crowds number six hundred, eight hundred, a thousand–who knows for sure. Monday, Tuesday, Thursday, Friday. Each day they wait for us.

Pierre is from Benin. At around 62 years old (his guess, not mine), he is our oldest translator and carries the most authority, and so is my right hand man to address the crowds. We always approach the group together: My standing next to him instantly bestows him with legitimacy, whether I like that or not. Here is Pierre, measuring in at just under five feet, clutching a megaphone, and my less-than-mighy frame, facing such a swell of people! What a sight it must be! I speak softly to him, and he translates to the people in Ewe. We explain the order of the day: Children first, then the elderly, then the adults. The yovo will hand out numbers. Do not come to her, she will come to you. If you start crowding/shoving/pushing/smooshing, she will not hand out any more numbers.

Mothers tug little arms through the double doors. Most of these young eyes are infected or itchy. Bob bends down, shines the ophthalmoscope into an eye, talks to his translator, who then bursts into a string of incomparable speech to mom. Eye drops here, ointment there, re-papoose the child, and they are on their way. Sometimes the problems are more severe. At one Friday clinic–held in a poor part of town–nearly all one hundred children presented with trachoma, a bacterial infection that can lead to scarring or blindness. Transmitted through contact with infected people or objects, or by flies.

Outside, Pierre and I sort the elderly. Several hundreds are gathered, but I must choose between fifty and one hundred to bring in. As Pierre explains that I will hand out numbers, the group nods in unison and responds emphatically when he exhorts them to be respectful during the process. I will only give numbers to those sitting down, he says. (Survival tactic learned from the first few clinics: Distributing anything means an instant gigantic doughnut of people around me. I now insist on bums on the ground or in chairs, and–voila!–much less smooshing.) Arms reach out from every direction, tugging on my back, my arm, my sleeve, my leg. “Help me! My seesta! Help me!” “Yovo, yovo! Save me!” Fingers point to eyes that shine back at me, bright silver with cataracts.

Inside again, three translators test the visual acuity of every adult. Your optometrist probably employs a chart with different letters, starting big and bold at the top and waning to minute print at the bottom. Here, to factor out illiteracy, we use tumbling E charts, and patients twist three fingers to indicate the direction of each E. They then filter to the center of the sanctuary, where a queue forms to see the doctor. Many require eye drops and fervent instruction to wash the eyes and eat foods rich in vitamin A. Some will have surgery to remove a cataract or pterygium, and are scheduled at the next table with Lauren. A few cannot be helped by medical intervention. Blindness. Impending blindness. They are led to a corner where Isaac, a quiet translator, waits to pray with them.

This work often makes me wish I could be ten places at once, because the inside workings of the clinic are enough to keep me bouncing from door to door, translator to translator, Bob to Lauren. Indeed, Bob’s initial explanation of my job, way back in January, was, “Don’t sit down. When you sit down, things start to fall apart.”

But the crowds outside again demand attention, so off we go! The groups of adults have either managed to organize themselves by this point, or else are in complete disarray. Some days I stand before them in silence, simply thinking about how order can be created from disorder. How to distribute numbers to the seven lines that have formed when I asked for one. How to act in a way that motivates each person to stay where he or she currently is, when surely the most advantageous method for the invidual is to plow forward to be the next to clutch a number. Even the most civil person is taken captive by the desire to be first in line.

Eventually, all of today’s patients (and some wannabe patients) are inside, and the clinic rolls on, successes and laughter, hitches and glitches and all. We end in prayer. Thank God for His people. And thank God for His grace.