First Impressions

After 24 hours of flying, driving and boat rides we have arrived safely in Sierra Leone, Freetown. We arrived to the Stadium Hotel at midnight where I am handed two candles and some matches with a message that the lights in our room don't work, I feel exhausted and all I can do is smile. It turns out nobody's lights work as the power is out that night, a common occurrence here (at least once a day). Our beds are very thin mattresses on a piece of wood and the bathroom is a picture. Thankfully our room has air conditioning which works most of the time which is such a blessing! In the morning I step out of my room to look down upon a massive graveyard and observe a few Africans are casually lounging over tombstones (where they have clearly slept the night). I look up to the lovely hills of Freetown that frames the city and notice a smoky haze that hangs overhead (all day long) from the open fires the people cook their food on. The smell of Africa invades all of my senses and I love it. I will be honest not all the smells are pleasant yet so many of them hold wonderful memories for me. I felt a peace as soon as we arrived and walked out of the airport, which is located a twenty minute boat ride from Sierra Leone's capital port city, Freetown. I am with a team of thirty two people from all over the world who will also serve onboard the ship this year. While we are here we will be working for three weeks with an Orphanage that is for Handicapped, Crippled and children that have suffered the pain of the disease Polio (which interfers with your nerves therefore causing grosteque and extreme contracture). We have formulated a Children's programme based upon the seven fruits of the spirit (Peace, Love, Joy, Kindness, Patience, Self-control, Goodness, Faithfulness and Gentleness) from the Bible that God teaches us to live by and love others with. They are an incredible bunch of kids and our programme requires lot of crafts which they thoroughly enjoy. We are also helping to paint all their buildings and do some repairs for them. The advance team for Mercy Ships arrives in the country the ship is headed to four months before the ship does. This year has been very hard for them as there has been a lot of work required. They play a huge role in preparation for the ship-building relationships with the people is a big task, organising all the immigration paperwork for the ship, scouting out the country, sorting the ship berth that we will occupy for eleven months. The team also has to find a hospitality centre-a place where patients can come to after they have left the ward on the ship yet still require support and post-operative care. The centre also provides a bed for those who are travelling from all over the country after their surgery. We have been given the responsible for converting an old warehouse into our hospitality centre. It will have one air conditioned ward in it and two other rooms where patients can recover once they have left the ship. It is so encouraging to know that this is where our patients will stay and just this very thought helps us stay focused throughout the days. It is hard work as we are constructing the walls, doing all the electrical work, painting and cleaning up the whole place. The main obstacle is the heat, despite the lovely cool sea breeze that occasionally washes over us-it zaps our strength up leaving us feeling exhausted by late afternoon. The traffic here is diabolical, it is so crowded and we are in a van that can seat eighteen. It is African transport and so the people we pass on the street wear shocked expressions as we fly by them all squished in like sardines travelling just as they do. As we weave through the market place selling all the junk the western world sends here I am never bored and often grinning from ear to ear at the entertainment and the children that wave us on. The people here describe themselves as “happy faced” compared to the “straight-faced” people of Benin and Togo. I immediately understand what they are saying as they are a smiling, friendly open faced people, especially compared to other West African countries I have visited. When I look around at the people I am in disimbelief that Civil War occurred just nine years ago. It began in 1992 and ended in 2002 yet still there are affects here. In these early days I find myself very aware as I look around the market place and realise that any person over ten years old has experienced war, has lost someone and still has the memories from it. The cause of the war is very hard to pinpoint and also complex however I know that Charles Taylor in Liberia had an influence in the Civil War here and helped to stir up and encourage the rebels. The main weapon in this war was terror and innocent civilians were the victims of devastating atrocities committed against them, I have decided not to write them in my blog as they are too disturbing. The famous movie “Blood Diamond” was a key in shedding light upon the suffering Sierra Leone has endured in history and opened the eyes to the Western World of the “child soldiers” and the sad realities of the war. The war was not about the diamonds however the smuggling did aid in funding the war and the weapons. I find it so helpful to gain knowledge about the history of this country so I can better understand the people here that we will be be working with and alongside this year. The ship will arrive in ten days time and we are anticipating its arrival. After living “on land” I now see what luxury it is to have the Africa Mercy, to flick the light switch and not even think twice about it not turning on:) When the ship arrives end of February we will be busy working hard to get the ship ready for patients and screening. The main screening of all the people will take place March the 7th where thousands of people from all over Sierra Leone and neighbouring countries will travel and gather to find out whether we can help them through surgery. I know this will be a very long day-especially emotionally as there will be people that we cannot help. Until next time, Godbless:)

Freezing in Texas

During our chilly time in Texas we had to undergo Basic Safety Training, which is training required by marine law for anyone who lives onboard a ship for long period of time. It included firefighting, First Aid and Water Safety and was quite challenging. On the day we put out fires with exstinguishers and fire hoses (oxygen masks and all) it was negative 15 degrees with windchill! The day we had to do water safety, which involved practising righting a flipped raft; there was snow on the ground outside! So much of the teaching was interesting and I feel like I learned a lot for survival (especially at sea). Some might think this is not important when the Africa Mercy is docked for 10 months at a time in each West African country we are serving; however there is always the sailing to each country that has to be undertaken and I do hope to be apart of someday :) At present our thoughts and prayers are with the crew as they sail from South Africa (where the repairs have finally and miraculously finished) and are on there way to Sierra Leone, we are all so excited for their arrival! Hope you enjoy the photos :)

Sierra Leone 2011

At present I find myself in Texas completing a four week course with Mercy Ships. Their main base is here and this is where the ships administration is run from. There are many reasons I am here and one of them is because I am now considered a longterm crew member of Mercy Ships and it is necessary to complete certain safety certificates required when you live onboard a ship. We are also spending some time in classes learning more about Worldview, Faith Foundations and Godly Principles to live by which are all so essential for living in a confined space and pressurised conditions in Africa. I am feeling so much more equipped and prepared to return to West Africa.

This year the Ship will be in Sierra Leone, the third poorest country in the world. Ten years ago Sierra Leone faced the cruelty's of war which ravaged the beautiful country leaving the people there wounded in more ways than just the physical.
I will in Sierra Leone from the beginning of February working with a Mercy Ships team preparing for the ship's arrival. The Africa Mercy will sail in near the end of February from South Africa. It has been sitting in dry dock for the last six months in Durban having repairs and new generators fitted by hardworking engineers. This year I will be part of the big screening of all the patients that will take place the beginning of March. I will be onboard for eight months working in the Operating Theatres.

Below is a short clip of just some of the Transformed Lives from 2010 Outreach.

There will be further updates to follow, Thankyou for taking the time to read this:)

Last days in West Africa...

12 July, 2010
Another ten hour day and I'm so tired...but I know this is all worth it. The race and pressure is on as there is little surgical time left and we all feel it in the Operating Room, no longer can we just say "Yes ok let's move that patient onto tomorrows list" as there is not space left so the days are getting longer. What struck me though with amazement is that decisions here are made a little differently here on the Africa Mercy. Firstly money is not even taken into consideration here and does not serve as the motivator to add patients to our lists. The heartbreaking decisions come with the decision to postpone patients till the next days list and the fear we will run out of time. Yesterday I was Co-ordinating the Theatres-a challenging role at times, which involves giving breaks to staff, organising lunchbreaks, putting away hospital supplies and generally trying to keep the ball rolling. It is also important for the Co-ordinator to make any adjustments to the order of the list and also arrange late staff when lists are running past dinner time. I found myself in agony Friday afternoon over a decision of whether or not to postpone a patient's surgery or go ahead with it. This is all about lives. We are all too aware that if we don't remove the tumour protruding from the person's face they will live with it for the rest of their life and eventually will suffocate to death as it grows and presses upon their airway. However there is also that point where crew and staff burn out and we don't want to get to that place.

Last week were two amazing cases. One I assisted
for was on 26 year old Collette who had a tumour
growth emerging out of her nose and looked horrific. As the surgery began it was clear this tumour was not superficial yet went very deep into head to the base of her skull. As it was dissected out and removed, a hole remained and I wondered how the surgeon was possibly going to reconstruct her face. With a metal plate and the Theatre running into the night, Collette was reported to be sitting up drinking some water later on that evening which was wonderful and encouraging news to receive.

Another case which was unreal was a woman who entered the Operating Room looking like she was pregnant with triplets. She had been carrying a 17kg Ovarian cyst for 12 years in her abdomen. It looked like six rugby balls being taken out of her stomach. I could not believe my eyes, what a relief to now she no longer has to struggle to walk without loosing her balance.

23rd July
Only 5 days of surgery left.

29th July
Surgery is over for 2010 Outreach in Togo. The last week was filled with long days and long hours. Everyone is breathing a sigh of relief it is over. Tonight I fly out of West Africa on my way to New Zealand. I plan to work a three month contract in Australia, saving all I can to return to Sierre Leone 2011 for the 10month Outreach Mercy Ships will do there. Sierre Leone is the second poorest country in the world.

I would like to say Thankyou to all those who have been so kind, supportive, read my blog and encouraged me while I have been here. I wish I had more eloquent words of appreciation to express my gratitude yet I guess I will never be able to really convey how grateful I feel towards every person who has extended their generosity and wonderful hearts. I will be updating this blog in near future.
Until then, Godbless :)

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.

The Face of Africa

In February this year the country of Togo had their Government Elections. Election season is always a time of unrest in this country as the history of the pain and suffering of 1993 echoes in the minds of every person here . During the month of February most of the people left the city of Lome to seek safety in the countryside as the memory of the violence is still fresh. In the 1993 Election 300,000 Toglese fled to neighbouring countries for safety; most had returned by 1996 however many are still abroad and some still in with refugee camps. Politically this country is still unstable which may be the cause of the unrest here and also the tension in the atmoshere. The Togo Government asked Mercy Ships not to do a mass screening in February in hopes of preventing large crowds and riots so screening has been carried out in smaller groups and teams have also travelled to the north of Togo.

There are local doctors and nurses from all parts of Togo being trained in the eye surgery rooms. Every day Dr Gary has two Togo surgeons (Dr James Amaglo and Dr Christophe Bissa) working with him-he is teaching them different, safe and effective ways to do surgery. There is one Maxillofacial surgeon for the seven million people of Togo. Maxillofacial surgery consists of working upon the face, soft tissue and bone reconstruction. Dr James Amaglo has been connected to Mercy Ships for sixteen years and whenever the ship is in Togo he comes onboard to glean new techniques and skills to help in the huge workload he has here. Just recently Dr Gary taught Dr James and Dr Bissa how to carry out Cleft Lip surgery. A Cleft Lip/Palate is a congenital abnormal facial development that occurs during gestation. A cleft is a fissure or opening-a gap and a non-fusion of the body's nasal structures that form before birth. One in seven hundred children are born with a cleft lip or palate and every ten minutes somewhere in the world a child is born with a cleft palate. This cause huge problems for the infants nutrition and ability to eat and most die in their first year from malnutrition, others will go on to survive however the battle to speak and be understood will continue to follow them all their days. In the Western world a child would be operated on at the first opportunity, here in West Africa an infant born with a cleft lip is considered cursed. The voodoo belief encourages the family and village to rid the child of the “evil” spirit b

y burying them in a wooden box and leaving them to die. If these children are spared, it is a result of the parents bravery; usually one of the parents standing on behalf of their child, fighting the village elders for the child's life. I could not believe it when a lady entered the Operating Room the other day with a cleft lip she had lived with for thirty four years, I wondered about the years of pain, ridicule and scorn she had endured.

It would be so easy to quickly point a finger at the cruel way they treat each other here yet to see these deformities and have no explanation must also strike fear in their hearts causing these people to act in irrational ways and believe in a religion that sacrifices their own children. With education and the visible change a one hour procedure brings the mindsets of entire villages are slowly being changed here and through many sources we hear the most wonderful stories of how parents stand confidently for their defenceless children who are born with cleft lips. Now that Dr Amaglo and Dr Bissa are equipped with the skills and knowledge of how to draw the puzzle pieces of the cleft lips together to form normal mouths we can leave Togo knowing that more children will receive surgery that will leave them smiling for the rest of their lives. Investment is key here and what we hope to leave, not dependency upon a big White Ship that sails in with free surgery.

A few weeks ago Dr Amaglo and his wife hosted a group of Hospital staff at their house. It was a wonderful night and with the help of their friends they put on a feast of African food and really honoured us-with live music and all.

As I mentioned in my last blog entry there is less freedom here in Lome (than last year in the Port city of Cotonou, Benin) to explore due to safety concerns so sadly it limits adventures however this weekend for the first time in six weeks I headed away with friends to Kpalime. It is further north and we stayed at a Baptist Hospital that has been here for 25 years, they have a nursing school there also where they train local people. It was a peaceful place and my ears rung with the silence as I realised for the first time in such a long time it was quiet. The airconditioning on the ship is nearly non-existent on the ship at present and it is clearly evident that we need to get to South Africa to have new generators put in. It works in the Operating Room however the rest of the ship is very warm and at times I feel like we are a tin can sitting in the African sun cooking. The generators all over the ship for this very reason are extremely noisy and working overtime, so silence is precious and hard to find.

We were just fourty five minutes from the Ghana border so we headed there and managed to visit the highest waterfalls in West Africa which are located in the town that sits directly on the border. Although I had the opportunity to visit this particular waterfall last year it was still a wonderful experience and great to get away.

That night we were given a tour of the hospital by one of the Doctors and it was incredible to see how they make do with the limited resources they have, some sights I will never forget. Towards the end of the tour he asked us if Mercy Ships had a Paediatric Ventilator and carried on to explain that they had a two day year old baby that required surgery on an Onphalocele. A very rare condition that is an abdominal wall defect which results in the abdominal organs protruding out of the umbilicus (navel) in a sac. A operation that many general surgeons tend to dislike performing as it has many complications. He asked if we could take the child with us back to the ship and explained that they had performed the surgery six times before and five of the children had died; I felt all the air leave my lungs when he said this. And so began the first of many phonecalls, yes we had a Paediatric Ventilator (a machine that helps children to breath after surgery) however we did not have the surgeon...and sadly their General surgeon was unwilling to come with us to the ship to perform the surgery-it was not an option as there were so many patients there that needed medical care at the hospital, he was the only surgeon there at present. All of a sudden I found myself at this point where I realised that the only hope, the only option was to leave the child where it was to have the surgery with the slim chance of survival. My heart felt so heavy, in my world...where I grew up there would be another option...there would be another way even if it involved taking a massive loan from a bank. Yes I believe in hope, I believe it is the anchor of the soul and because of this I had to walk away for a moment and cry tears of despair and pray...there was no other option.

I am thoroughly enjoying the work being done here. Each day is filled with amazing surgery and lives that are transformed. I am not saying at home lives do not get changed daily, however the drastic and extreme change takes my breathe away sometimes. If I do not keep reminding myself of what we are doing I can let the routine and familiarity of eye surgery get the best of me-everyday approximately thirty (often more) people receive their sight back. Light flows literally back into their lives and the loved ones around them who have cared for them for such a long time. As I witnessed four operations on children under the age of five who were completely blind receiving eye surgery and sight I realised that nothing here is ever mundane...only my attitude.

Everyday is filled with miracles here. Plastic surgery has just finished and Dr Tertius Ventor performed complex surgery and managed to operate on seventy patients in the time he was here. It was such a priveledge to be apart of the surgery for a man who had been carrying a seven kilogram tumour on his shoulders for 17 years. A tall man in stature he walked into the Operating Room looking towards the ground because of the weight of the tumour I was struck by the physical burden that he had been carrying upon his shoulders for all of those years. Research has shown that if the body receives physical trauma “lipomas” which are a fatty soft tissue (non-cancerous) tumour can begin to grow giving the look of a huge lumps or growths on a person's body. He told us that he had been beaten by the back of a rifle seventeen years ago and that was when it had begun to grow.

Mark Shrime was here for two weeks as an Ear, Nose and Throat surgeon and during this time carried out some miraculous surgery. I watched amazed as he removed a 1kg Goitre (swelling in the thyroid gland) from a Lady's neck, afterwards it looked like he had applied a bandaid or a plaster over her neck; there was no sign of what had been. As she had arrived in the operating room I had heard her struggling with every breathe.

Some days here are thirteen hours of work, others are eight. One night an Operating Room team worked till 2am in the morning-removing an extensive tumour from a lady's face. Regardless of the number of hours and how tired I feel I am grateful for every day and don't want my time here to end. There is no payment received for this work and for these hours yet I love it and love being apart of the work that is being done-good changes are taking place in every area of life-the physical, the spiritual and the heart of every person who boards this ship.

Where I am meant to be...and filled with Hope.

I have been writing this blog for three weeks now. I should have just posted it with every addition as it has now become a small novel, I'm sorry about that :)



22nd April: After sitting in airports for seventeen hours and on various planes for seventeen more I finally arrived in the Port city of Lome, the country of Togo, West Africa. At one in the morning it was a great relief to see my luggage approach me on the (ancient) carousel and to embrace good friends who took me safely to the ship. As I ascended the gangway to the ship and stepped onboard I instantly felt at home-everything felt so familiar and a deep peace poured over me...the revelation swept over me as I had the realization “wow, this is without a doubt where I am meant to be”.

The next day was filled with wonderful hugs and welcomes as so many familiar friends and faces greeted me. I walked into the dining room at lunchtime (at its busiest hour it usually seats 300 and is very noisy) and there were delighted cries as old friends who had not known about my return saw me-it was overwhelming but also encouraging and a lot of fun catching up with people.

That afternoon I headed off ship and as we left the Port I inhaled the undescribable yet unforgettable smell of Africa-it is not one that makes your nose screw up and your stomach repulse-more a mixture of the red earth, and the people. The humidity and heat hit me and I after I had walked ten metres my clothes were sticking to me. I have the comparison of last year in Benin often in my mind, sometimes this is good and bad. The atmosphere in Togo is much more electric and I can feel the tension here. I now see how safe we were last year in Benin and how much more freedom we had, all the crew here have been given clear instructions regarding safety. I think the Port in every city in the world would not be very safe and sadly we have found it to be very dangerous just outside the Port gates of e in the Port of Lome. On the ship I feel safe and we are very blessed to have drivers that shuttle us wherever we want to go around Lome. In a sense I feel like a part of my freedom has been taken from me-despite this I still feel that being here and doing the work I am involved is worth it.

I run in the mornings at five thirty with our Ship Security guards-they are Nepalese Gherkas and I feel very safe with them and they also set quite a pace:) On Sundays I run to the Ghana border and back which is 20kl in total-we begin at 6am and by 8am the sun is scorching.I was amazed to see hundreds of local people out-Sunday mornings is their sports time, it was really nice to see the people here enjoying themselves as life here can be so harsh. The beach was covered with hundreds of people playing football and there were running groups of over a hundred. At one point we found ourselves among a running group that was over a hundred people; it was a lot of fun-the people in the centre of the group carry musical instruments and everyone was singing-the atmosphere was so joyful and it helped me to keep tting one foot in front of the other. Every Sunday I have a little friend who joins me (usually for 10kl) his name is Joel, he is eleven and speaks english perfectly as he has just moved to Togo from Ghana (english speaking) with his family. Each time I see him he gives me a big hug and keeps me company as we push through the heat.

Mercy Ships visited Togo the first time in 1991 and this is the fourth time we have been here. Dr Gary Parker is the chief Medical Officer onboard and has worked as a surgeon on Mercy Ships for 23 years. I inquired whether he can see a significant difference in the people's health from the first visit the Ship made to Togo. It is wonderful to hear him say that the improvement in their health and the effects that have taken place is overall significantly better since the first time the ship came nineteen years ago. Despite this there is still so much need and the reputation of the work we do goes before us and the queues are very long-there is no need to encourage the people at all-they will travel from far and wide and there is a desperate need. As in every country it is amazing to see how the people of Togo are amazed when they see the tumours of great size and deformities that present themselves. So often these individuals have been hidden by their family, suffering in silence and isolation away from their community and loved ones only to emerge with the glimmer of hope that they may receive surgery and be accepted once again. There is so much sadness sometimes in their eyes that it is heartbreaking-many of them will not make eye contact due to shame.

The outreach here in Togo will only be for 6 months as the ship sails to South Africa end of August to have generators that are urgently required fitted there. I was informed by one of the surgeons the other day that even if we operate for 24 hours a day we could still not complete all of the surgery that is needed here. The people of Togo are crying out for more yet it is sadly not possible. How can we possibly decide who needs the surgery most?or whose life should be changed forever? There is always dissapointment yet there is also always hope.

Once the patients receive surgery and have had post-operative care in the ward and are comfortable we transfer them to the Hospitality centre. This is located on land and where patients stay so they can return to the ship for checkups on their wounds and extra care. My first Sunday I attended church there and found myself a little shocked at the large tumours I saw-people awaiting surgery. I thought after last year I would not be so astounded yet to see these people and for just a moment to imagine what life must be like with a 3kg tumour hanging off my face makes me shudder and wonder at how strong they must be-not just physically but emotionally. Orthopaedic surgery has just finished so there were many sweet children hopping around on casts (with shoes made out of road tyres) and big grins on their faces-they are fully aware their legs are no longer bent in funny angles but straight like their friends. As the singing and dancing began to reach its climax I clapped with joy and also observed a little girl of age four with a gorgeous smile making her way across the room to me-she had a cast up to her mid-thigh on her left leg and she was persevering down the makeshift aisle, hopping along and keeping her eyes set on me-as she got to the row I was seated in she proceeded to climb over three people before she was standing before me-her arms stretched out asking me to pick her up. I gently pulled her into my arms and she then covered my face with kisses-she was a little character and after lots of hugs she took my hands and taught me to dance-shaking her little hips with more rhythm than I could ever hope for. Halfway through the message I looked behind me and made eye contact with a woman who had severe Fibrous Dysplasia all over her face. A condition which causes abnormal bone or tissue growth and is incredibly disfiguring. Her face looked as though it had twisted upon itself and there were huge abnormal lumps on her head which her hair was hiding. She was holding a baby to her chest and as she quickly looked away from my eyes I could see there was a mixture of sadness and shame in her eyes. I kept looking at her-waiting for her to raise her head-after a minute (that seemed like an eternity) she looked up at me and I smiled-I didn’t look her face-or the bony protrusions coming out of her cheeks-I kept my eyes upon hers so she would see I wasn’t looking at how badly she was disfigured-I saw surprise in her eyes and then a smile crept across her lips. I turned to face the front again to listen to the African preacher (there were four translators for the local languages here) who was speaking about hope…how there is always hope.

The following Tuesday I was in surgery with Dr Parker. It was the first time being back in the Operating room after six months away ( I worked with the elderly in New Zealand when I was home) so I was feeling a little rusty. One of the nurses said “I’ve written you down to assist and scrub for the Lady with Fibrous Dysplasia” and I said “great” thinking it would be a small case. As the lady from the hospitality centre entered I realized this was not going to be a small case. The surgery took five hours and was very intense. I felt filled with emotions I could not describe and felt myself thinking of what a hard life she must have had-the years of bone growing and slow twisting of facial features taking place, the emotional turmoil as friends and family looked away or upon her face in shock and confusion. On this ship we carry out surgery hoping to bring healing to a person's body but what about their soul?all of those years of pain and emotionl suffering they have endured. As I have the priviledge of praying before every surgery with the patients-asking God for his help in every simple operation and every complex one, I also ask for the emotional healing for them-for that healing which as nurses and Doctors we can not possibly bring with medical care.

At the end of this operation I felt weary yet a deep sense of contentedness as it is so good to see what change can take place in a person’s life in just five hours.

I have been here three weeks yet I have lost track of all time, it feels like I have been here for two months. Life is so busy on this ship-after long days in the Operating Room there are always friends to spend time and activities going on. I’m enjoying being back so much. I feel so grateful when I think of every person who has contributed to help me return-once again my dreams are coming true and without the generosity of amazing people in the world I would not have been able to make it back.