Some photos..

Just some of the patients who have been on the wards....

The beautiful Tani, a patient from 2010 who sustained burns to the right side of her face. She received an operation in 2010 for a skin flap and graft and reconstruction of her nose and has come back to receive further reconstruction and a possible right eye prosthesis. This is a picture from 2010 and she has grown so much! She is so full of energy, we played countless rounds of jenga at the weekend! She has travelled from Dahpong in the North of Togo with a man from her church, who thought nothing of coming with her to be her caregiver while she has the surgery and recovers.

 One of our 120 goitre patients; at the screening day there were more hernia and goitre patients than all others. We ran 4 thyroid clinics within the first few weeks in the horrible task of trying to prioritise as we only have 60 slots. Some of the thyroidectomies have already begun and the patients are recovering well.

Little daniel who was one of our first patients to be operated on; what a smile he had!

 Komi; a 6 month old who has a large encephalocele (an outpouching of his brain past the skull boundaries). Although 6 months in chronological age, he behaves like a newborn still retaining the primitive reflexes found at birth. He also suffers with seizures, which occur every few mintures. Unfortunately the CT scan we performed showed that he has little actual brain tissue and very large dilated ventricles (which carry the fluid which bathes the spinal cord and brain). We are liasing with him and his family regarding a possibility of some surgery if his condition stabilises. Please pray for them.

 Chantal, a 25 year old from Ghana originally, who sustained burns to her right arm as a child. She underwent a contracture release and skin graft in 2010 when Mercy Ships was here in Togo and this healed up well initially. However this broke down a year later and she has spent a year and a half with the arm like this, covering it with a blanket and being ostracised because of it. We have had her on the wards for a few weeks and taken her to theatre to clean the site prior to hopefully doing a skin graft. She is such a brave lady and hadn't been on any pain relief before we saw her at screening. Please pray for her as she is going through such a lot right now and faces many more hurdles in the future.

 Radiatou, a young woman who has been suffering with fibrous dysplasia underwent her operation last week and has since been discharged before returning for further alterations. The marketing team picked her up at home and brought her to the ship; she was very excited as it was the first time she saw the sea! They also went back to her village with her when she was discharged and her headteacher said she was excited to have her back in school when she is well enough!

Wards

So this week we now have 3 out of the 4 wards up and running...max fax began a couple of weeks ago, with plastics and general surgery beginning this week. Has been a busy few weeks, sometimes feels like just about keeping my head above water, more so with the emotional side of things I think. Is hard to not just give into all of the emotions that fly around your head or to do the opposite and shut them out and not see the patient in front of you as a person, beautifully and fearfully made in God's image.

The very first day was very tough as we had 2 scans that came back from young patients (both in their 20s), showing large tumours (probable lymphomas) that we could operate and treat with chemotherapy and radiotherapy at home. However we had to admit that we do not have the means to treat them; there is no proper oncology service here in Togo. I called the patient life team; an amazing group of people headed by Clementine Tengue (a Togolese woman who has been working with Mercy Ships for many years), who then broke the news to both patients that we could do nothing for them medically apart from offering palliation and prayer. Walking back to the ward trying hard to compose myself I bump into the chief medical officer and max fax surgeon for the ship who asks the dreaded question "Are you ok?"

To which I descend into a bit of verbal diarrhoea and blink back tears, he then says 'You have to care, the minute you stop is when you should stop being a doctor..'

Is hard to care, it costs to care, but I would much rather be valuing people and showing them love and ultimately God's love and view of them then shutting myself off. Dr Gary had also said the importance of looking the patient in the eye to show them you see them and not just their deformity and I really learnt the importance of this a couple of days ago when I was admitting a little boy for removal of bony overgrowth and tissue from his face. He is 7 and is from Ghana. He came with his mum, wearing a teatowel over half of his face and a hat to keep it on. He wouldn't make eye contact during the whole consultation and kept on fidgeting with the cloth to make sure it was still covering. When his mum took it off to show me he hid his face in her lap. This (medically is known as fibrous dysplasia) and has resulted in an overgrowth of all the bony structures of the left side of his face. This has left his face hugely deformed with his left eye pushing outwards and his vision quickly deteriorating. He has also been suffering with recurrent nose bleeds and finds it difficult to eat and now breathe. When I was examining him, through my stupid dancing and gesturing we got a smile and I think he realises now we are all seeing him and not the growth, which has ostracised him for so long now. He is a different little boy on the wards already and has gone for his operation today, please be praying for him as he recovers. A specific prayer for him is regarding the need of blood; his blood count was very low when he came in and we gave him a unit pre operatively. However he has a rarer blood type amongst the donors on board (they call it the 'walking blood bank' as when a patient requires blood, the donor who matches their blood group is called to give a unit). We only have 3 donors left with his blood type currently registered so are running out if he needs some more.

I'm excited to see his first look in the mirror; has been a great moment with all of the other patients peeking a look underneath their bandages! Will hopefully get some photos of him to share..

"Not by might, nor by power, but through my spirit says the Lord" Zechariah 4 v 6

Some news from admissions..

Every weekday the ship's population gains about 100 'day workers' who we work alongside in all the activities of the ship, whether that be house keeping, deck work, galley work or, extremely helpful for me, translation purposes! In my work in the admissions tent out on dock I would not be able to do this without the team of Ruth, Emmanuel, Edem and Esther who can speak a multitude of languages between them and they astound me with their ability to switch between the many different dialects and languages that exist between the different tribal groups here in Togo and also further afield. History taking at times can still prove difficult and this was shown on Friday when we had a little boy who had been brought by his parents from Benin. (News of Mercy Ships appears to travel far and wide and just this week we have had patients who have travelled from Nigeria, Benin and Ghana to be seen)

This little boy is from a Muslim family and they live in the north of Benin; according to his parents the large swelling on his neck has been there since birth but recently it had begun to become very painful and much larger so they had taken him to a local hospital. Here they had attempted some kind of procedure but finding it too difficult to carry out they said there was nothing more they could do and sent him on. Arriving at the Mercy Ships Admission Tent on the dock on Friday afternoon they told me that we were their last chance for him and that they were completely in our hands. He was understandably terrified and frozen with fear as it must have been a overwhelming, to say the least for a 6 year old, to have been unwell, in pain, travelling across Benin then into Togo, seeing the sea and a boat for probably the first time, being brought onto a ship, put in a CT scanner and then poked and prodded by all these 'yovos' (the affectionate name I'm told for white people..though the original meaning in Ewe is 'cunning dog!') No smile has crossed his face yet, especially on the ward round this morning, when he was told he would have to go back to theatre but the corners of his mouth curled slightly when we played with cars earlier so we will see!

Please pray for him and his family that they would be impacted by the times the patient life team spend on the ward explaining the gospel and that we would be able to help him. From the scan it was unclear whether or not an operation would be fully curative.

Screening..

Elijah

So first of all I need to apologise for the delay with this update, has been over a week since screening and only just getting round to it now. The hospital properly opened to patients on Sunday and the first cases started on Monday so has been a very busy few days!

Screening was an amazing, if very overwhelming day; 4000 people turned up at the city's football stadium and waited from the previous evening to be seen. Out of these 1600 were seen and examined (there is an initial pre screening to filter those that we are unable to help) and then we allocated 560 operation slots for these patients. It really hit home just the massive need here and unfortunately out of those 4000 the small minority that we are able to help with the facilities we have on board.

I was based on the maxillo facial station and we were very fortunate to have 3 max fax surgeons (1 who has been here with his family for the past 25 years and the other 2 who are also very experienced with Mercy Ships but who come out for the initial few weeks every year to help). There was also a couple from the UK who have been coming out for a few weeks each year to do the pathology and biopsies for the tumours. This was an amazing aid to enable us to have more of an idea of a diagnosis when I came to review the patient.

Some of the tumours and growths we saw were just awful and at a stage you would never see at home because they would be resected before they became that large. They were very disfiguring and often would cause the patient to be ostracised from their communities or families.

The general surgical station was similar but we had a much higher frequency of patients (over 450 hernia patients and 120  thyroid goitres to be seen) so crude screening was done to allow those we thought we may be able to help to come and be assessed properly on the ship at a later stage. Currently this is all hanging in the balance anyway as they have had a lot of cancellations from the general surgeons they were expecting. So if anyone is a general surgeon or knows one please get in touch! Some of the pictures from the goitres are below. There tends to be a far higher frequency here due to lack of iodine in the diet.

Overall screening was a great day; the whole crew of the ship (about 400; non medical and medical) were involved with the security and general running. It all went very smoothly; compared to last year in Sierra Leone where there were more problems with crowd control and rioting.

Is beginning to hit home though now just how often we have to say no to patients who we could easily help with the resources we have available in the West. A lot of babies are born with encephaloceles (an outpouching of the brain and membranes due to a defect with skull fusion). We saw a lot of children with this problem and have scanned most of their heads to see if we can help. Unfortunately there is no neuro surgeon on board and no affordable neuro surgical facilities in Togo, so we have had to turn away at least 5 children this week who we know have not got a good prognosis or normal life expectancy without surgery.

One of these was a beautiful little boy called Elijah. Him and his family are refugees from the Ivory Coast and came to us at screening. We were all hoping and praying that it would be a yes with him but unfortunately this morning I had to explain to them that there was too much of his brain in the outpouching for the operation to be done here. However we are able to send the images and some details of his case to a neuro surgeon in Germany who is going to see if he can advise or maybe even come! We were able to pray with him and his Mum this morning and she had faith that was very inspiring; just peace in God's will whatever that may be! So please be praying for him and his family.