Where there is Darkness....there is Light

This morning I attended the Hospital Ward Church Service, which is always a joyful and energetic experience. I always imagine that every patient after surgery will be in recovery mode and wanting to stay horizontally in their beds, however this is definitely not the case here especially during the worship part of the Church services. With the beat of the beautiful African drums it is impossible to keep them on their chairs, in there beds or to stop my own feet from tapping. They dance with wound drains and catheters bags pinned to their hips which I am sure any health professional would laugh to see and they raise their hands towards heaven in praise and filled with joy because no longer will they be the outcast of their village.

Last week I found my heart was moved as they had “dress ceremonies” for ten woman who had received Vesicovaginal fistula surgery. This is not something we do routinely for the woman who have surgery on this ship, however these ladies have often had very painful and difficult journeys and we rejoice in what is the beginning of new life for them.

VVF and RVF (vesicovaginal fistula and rectovaginal fistula) are serious complications of childbirth, where prolonged labor results in serious tissue damage and creation of holes between the vaginal wall and the bladder or rectum of a woman. The condition occurs more often in developing countries where women become pregnant at a very young age.

Their small pelvic size and lack of access to proper medical care during childbirth results in the type of obstructed and prolonged labor that causes VVF. Living with the effects of this condition can be devastating. Women are often discarded by their husbands, ostracized by their families, and live as social outcasts with noway to support themselves. They not only find themselves abandoned by friends and family but also leaking urine continually, the smell driving their loved ones away and often out of their villages far from social contact.

This year I had my first encounter in the VVF Operating Room and I have to admit I was a little nervous as I do not have much experience in Gynaecological surgery and all I could think was “How will I be able to relate to these woman?”. However I was surprised to find my heart was quickly captured by these incredible Ladies.

22 June, 2010

Today I did the Pre-operative check of all the documentation for a patient coming to Theatre for VVF surgery. They had done all the consent for surgery, explaining and the right checks with this patient on the ward with another patient who spoke her language and was able to translate what she said into French which was then tranlated into English. Despite this language barrier I was able to gather rather quickly how excited she was to be coming to Theatre for Surgery as she was smiling, laughing and clapping her hands from time to time. As I read her notes my heart silently broke as I saw she had been married at age 12, she had been leaking for 10 years and she was a widow who lived alone in a remote village far up North of Togo. I walked beside her and guided her into the Operating Room, helping position her on the bed and stayed with her while they did the Spinal. A procedure that is performed by the Anaesthetist, with correct placement of Local Anaesthetic in the Spinal space a temporary “paralysed” affect can occur, leaving the patient numb from the waist down for up to four hours. I placed my hands upon her shoulders and she leant her head against my neck-at one moment she looked into my eyes and just smiled. A theatre nurse and good friend next to me whispered quietly “She probably hasnt been touched in years-these woman are considered unclean”.

I have found that unlike the Western World there is a great emphasis here in Africa placed upon having children. It is unheard of and unacceptable to vocalise “I am focusing on my career instead of having children”. Their thinking seems to be “A woman's purpose is to have children” and if this is not physically possible then your value as a person is not as high, you are considered worthless in your communities eyes. Just this week a local surgeon who comes daily to work onboard to assist and learn more about different operations said to me "Melanie, you need to have some babies" and I laughed and tried my best to explain "I understand how it may be here or other people's decisions, but for me personally I would like a husband before having children"...he still did not understand:) In Africa to have children is the richest blessing and of highest value, if you are barren then it is often concluded you are cursed. So not only are many of these woman left with perforated bladders, leaking urine and smelling continually; they also have to face their ultimate failure : no children.

We have translators on every ward, local Togolese people who work onboard daily to help us communicate with our patients as they either speak French or Ewe, which is their main language (among many others). A good friend who is a Ward nurse said to me the other day “Mel you will never guess what a translator said to me today-we were talking about VVF and he said that now he knows about this condition if his wife ever gets a VVF he will not leave her like most of their husbands do”. We discussed how amazing it is that we often think only the patients lives are being changed here, yet the effects seems to be ever widening and mindblowing. I was struck with the realisation of change that comes when education, knowledge and love are utilised effectively.

Once the woman have received surgery and are definitely “Dry” they are each given a beautiful new dress and pampered for their special day and presentation to their friends, family and the nurses who have cared for them. They sing, dance and share their stories with all who are present.

As one woman shared her story my eyes filled with tears. She shared how fifteen years ago she was having trouble delivering her baby so she sought help at a local hospital where they carried out Caesarian-Section. Thankfully the child was born healthy and well. Sadly though after this though she experienced leaking of urine continually and every hospital and doctor she approached was unable to help. She finished by saying “I praise the One God for my child because he was the one that brought me to Mercy Ships and now I am free and dry for the first time in fifteen years”. Another Lady shared how she had been leaking for thirty five years and felt free for the first time. I have learnt so much from these incredible woman and I am grateful for the opportunity to be a part of their journeys.

Lately I have been thinking a lot about Beliefs. A topic that may often cause people in the Western World some discomfort however here I guess I feel more freedom to speak openly as I have found with the African people what they believe is an integral part of who they are. So I guess I've been thinking...We all must believe in something...whether it is God...your family...your country...your job...or some other religion?

These thoughts all struck me as I was driving along a beach road the other day and there were White Flags everywhere which signifies only one thing here: Voodoo.

There is much mystery around this particular religion and it does not just consist of “Voodoo Dolls”, it is much more than that and has many dark elements. Voodoo is the worship of Spirits, in West Africa often they place emphasis on the spirits of their ancestors. Fetish objects such as dried animal parts or statues are sold at markets for their healing and spiritually rejuvenating properties. Patterns of worship follow various dialects, gods, practices, songs, and rituals. In Voodoo the practice of offering an animal sacrifice is common as a way to show respect and thankfulness to the gods. This may be the reason for not seeing many dogs around Lome or in any other parts of West Africa I have been. Disturbingly human sacrifices are still also a commonly used practice.You know that people believe in something when they are willing to sacrifice something as valuable as a human life.

The reactions I receive from people when I have told them that I am travelling to West Africa is often suprise and I have heard this particular comment more than once : “Oh you are going to Darkest Africa”. I very quickly discovered however that this part of the world is not “Darkest Africa” because it is poor and dangerous, it is clear now to me that it is deemed “Darkest Africa” because of the dark spiritual beliefs here.

I have to come to the point of acknowledging that what they believe is real. I do not believe it is truth but just that there is the presence of darkness here. You may think that I am naïve and ridiculous to think this, but what I have seen here is unlike any other place and there does not always seem to be a medical explanation as the Doctors on the ship often tell me. We have patients who present here, tumours protuding out their faces and when we ask them when the tumour began to grow there are many who respond the same way. With a serious and intense look on their face they say “It was a Voodoo curse, my neighbour cursed me and that year it started to grow”. At first when I heard this I automatically internally thought to myself “Yeah right”, however after hearing so many similar stories continually being presented this got me wondering about their beliefs. Belief governs all you do, the power of unwavering belief, it is followed by action which is accompanied with an outcome. As health professionals we are always looking for the medical explanation and reason for a condition, but honestly if you were here and you could see what I am witnessing maybe you too would begin to wonder too.

This has all helped me to understand more about what I believe. What has made me give up my friends, my family, my job, financial security and the comfort and luxury of home to come here?what do I believe that pushed me out of my comfort zone and into this realm? I guess the belief that God cares for and loves the people of Africa just as much as he loves me, that there is more to this life than just me and what I want. How did I get to this place where I find myself in West Africa living out my dreams? Giving all I have and appreciating every person back home who is also helping me fulfill this cause? Finding out who Jesus Christ is and the sacrifice he made, helped me to come to this point where I was willing to make sacrifices in my life. In doing this my desire is to show those around me who he is, choosing actions to do this rather than words. The world here is full of aching pain and despair so how can I use the resources and skills I have to somehow make it better, not save it but simply try and leave it with more joy, love and hope. I want my life to count for something real. This is my belief, I do not want to force it on anyone. I believe this is where I am supposed to be and who I am supposed to be giving too. Hope is the anchor of my soul and this what I would like to give to those who possess none.