Day 5 - September 30

What a day! Before lunch I helped screen about 200 people for dental care and observed three surgeries!

Every Monday and Thursday, Mercy Ships screens the locals for dental care. And by dental care I mean mainly extractions. They have a team of dentist that work in a building near the ship Monday - Friday. On Mondays and Thursdays, they screen people that need immediate care and treat them that day. For the others, they hand out appointment wrist bands and they treat them on the other days. The process is really pretty cool but really sad too as so many people have to be turned away that really need care.

The way it works is the men line up on one side and the women on the other. The children get their own line behind the women. This is all done outside. Today it was super hot. At 9:00 two screeners came out. They are not dentist - just trained to look at teeth. They screen the children first and treat all that need care. After that they each have 20 appointment cards for the day and 20 appointment wrist bands for the other days. My mom and I walked the line with Jenny, one of the screeners, for security reasons. Apparently the crowds have really gotten out of control in the past and we were there to help get Jenny back to the compound if the situation went awry. Ok - you can all stop laughing now. I realize my mom and I are not exactly the two most intimidating people in the world. 

Back to my story...

Jenny took half the men and half the women. She walked down the line the first time looking for obvious swelling. Anyone with swelling gets a card for immediate treatment. Some try and fake it but she knows better. After that, she re-walked the line and each person opened their mouth and she looked inside. Being that the crowd was quite gentile and not the least bit out of control, mom and I took the opportunity to take a look with her. (Jodie - I know how you feel about teeth - look away now). Keep in mind, this is all happening right in the middle of a hot muddy field in front of 200 people. The majority of the people had teeth that those of us in the states would consider in desperate need of attention. Many were missing teeth, had rotted teeth, broken teeth, black teeth, 2 teeth total, pretty much an array of decay. It was very sad (I know I say that a lot but it is). Jenny could only take the really bad ones and the rest were sent home to try again Thursday. Some have been coming back for months and still aren't urgent enough to warrant treatment. Several people Jenny sent in for treatment would need their remaining teeth pulled and she told them they had no replacements (Mercy Ships had 500 sets of dentures to start but is already out). They agreed to have all their teeth pulled, even knowing that. I asked her if they would go get dentures elsewhere and she said they probably wouldn't because they are very expensive.

Besides checking out teeth, I was in charge of putting the wrist bands on the people Jenny designated for later appointments. As I walked up and down the lines with her, I held them in my hand. I may as well have been holding bags of money or gold bars. I heard many of them murmur about the wrist bands and I could tell they were watching my every move. It was a little unsettling but I wasn't too worried as the people of SL aren't violent. Just desperate. My mom had to mark an X over the wrist band (where the sticky part is) to make sure they don't try and remove it and give it to someone else. This was a huge problem in the past. When Mercy Ships first arrived, they treated people on a first come/first serve basis with the dental clinic. The locals started camping out for spots in the line and they would sell their spots. They were also selling their appointment wristbands. How tragic that someone that desperately needs dental care needs the money more and is willing to let their teeth rot to get it.

After everything was handed out, everyone else was sent home and we went inside the clinic. Those that are being treated that day have to sit and wait until they are called. Sometimes that is all day. While waiting, a volunteer teaches them proper dental care and diet. Part of the reason their teeth are so bad (besides lack of dental care and proper oral hygiene) is their diet. They eat very surgery and processed foods and chew a lot of surgery gum and hard candy. They also smoke a lot. Jenny told us some people would show up with soda in their baby's bottle. 

The area where they treat the patients is a big room with 4 or so dental chairs. Each dentist has two assistants. There was also a hygienist. In the middle of the room is a huge table full of sterilized dental tools. It is a pretty nice operation.  I really enjoyed seeing it and it is super cool that Mercy Ships does this. It was one of my favorite parts of the day.

Next it was off to observe surgeries. Mercy Ships is kind enough to allow us in the operating rooms as long as we don't touch anything (duh). My first surgery was a 4 year old with an encephalocele excision. Basically it was a large growth between his eyes on his forehead that CSF was leaking into. It was very disfiguring, caused the little boy to be terribly cross eyed, and let's face it, CSF should not be leaking into the face, so I am sure he had a host of other problems as well. Poor little guy! When I arrived they were half-way through excising it. I am not real keen on the whole surgery thing (especially not 2 feet from me) so although it was super cool, it also made me queasy. I actually was more interested in the anesthesiologist. During the surgery, his blood pressure and heart rate started climbing. The anesthesiologist injected something into his IV and his heart rate and blood pressure immediately went down. I asked what was injected and it was morphine. Apparently you can still 'feel' pain even though you aren't consciously feeling it. It is a sympathetic reflex in the basal part of the brain. I am sure I learned this at some point but totally forgot it and it was super cool to see in action. So, the little guy didn't know he was in pain, but his brain did. Go brain!!

Next up was a salivary gland tumor (which actually turned out to be just a really clogged and swollen gland). When I got there, they had the 'tumor' fully exposed and were checking his nerve reflexes. They needed to be sure they didn't cut the nerves or he risked hearing loss and/or facial paralysis. The OR nurse was super cool and was pointing everything out. She motioned to some really gross looking thing on the tray and pointed out the lipoma they had just removed. I could have lived my whole life without seeing this guy's 'ball of fat' (as she put it) and I especially could have lived without her graphic description of, "it just pops right out - it is in its own capsule." Ick. I appreciated her willingness to describe everything and she didn't know I was all queasy about these kinds of things, so I don't fault her. My mom would have loved the ball of fat talk. She couldn't get enough of the blood and gore in the OR's. She would have stayed there all day had they let her.

Finally - cataract removal. I didn't think I would like this one because I am especially queasy about eye procedures, but this was actually my favorite. The procedure was up on a monitor with it really zoomed in on the lens, so it didn't really look like an eye up there - just a large circle. The doctor inserted all sorts of needles and blades and things (yes, I know, my medical terminology is impressive) to excise the cataract. It took about 10 minutes to get to that point. When the cataract was loose, he used what looked like an inoculating loop to remove it. He then cleaned out the area and installed (I am sure that too is the medical term) a permanent lens. He then pulled the  skin back over the incision and cauterized the tissue in the corners and was done. Whole thing took about 20 minutes. It was super cool. Shortly after they pulled the cataract out, the nurse brought it over for me to see. Talk about queasy! It looked like a small round tablet of wax. And then she started stabbing it so I could see how thick it was (typing this is making me gag). Then the other nurse brought over a vial of all of the cataracts they have removed. As I feigned interest, I was trying not to visibly gag.

Looking at a vial of removed cataracts - check. One more off the bucket list...:)

While the doctor was working on the cataract, they prepared the other patient by inserting a very long needle into the skin under his eye. The syringe was full of liquid and it took her about a minute to push it all in. The guy didn't flinch. I would have been freaking out seeing a needle that big coming towards my eye! I did ask one of the other surgical nurses about the demeanor of the Sierra Leone people in the OR and she said they are very stoic. They do not say much and rarely express fear. I am sure a whole bunch of white people doing medical procedures in a hospital inside a ship is a bit foreign and unnerving to them!

The most amazing part of the surgeries is they are all being  performed on a ship that rocks back and forth every 8 seconds!

I asked one of the surgical nurses what they did with the biohazard waste. They have an incinerator on board and burn the biohazard material on the ship. Initially they were throwing away drapes, used IV bags, etc. However, one day, one of the volunteers went to the slums and saw one of the locals selling a pile of used drapes. Blood and all. Now they cut the bloody areas out first and incinerate those pieces and throw the rest away. They also now have to incinerate all needles, medicine bottles, IV bags, etc., because the locals dig them out of the trash and resell them, just like the drapes. With the medicine bottles, they will put whatever in them and try to pass it off as the medicine on the labels. With the IV bags, they refill them with water and sell them as the labeled solution. The desperation in acts like that is not even comprehensible to me...

Morgan worked with OT today and worked with the burn victims. Many had been burned in the war and their injuries healed with massive scar tissue that limits their mobility. Arms that can't extend out, feet that are permanently turned upward, fingers curled up into a fist. All needed surgery to excise the scar tissue, replace the skin with graphs, and then PT to get motion in the appendages. It is very painful for the patients and Morgan said they screamed in agony during the sessions. Although painful to watch, Morgan was very inspired by their plights and it reaffirmed her decision to go into OT (I originally said PT when talking about Morgan, but it is OT). Morgan watched a skin graph surgery and I have pictures of the graph to post (so icky).

Dr. Stuart wanted me to let you all know the shunt arrived today (29th) via Laura from Virginia. As I am typing this on the 30th, I am happy to report the surgery was a success and the nine month old with hydrocephalus has his new shunt! Dr. Stuart was able to get it donated. That's like a $5k donation. Super cool. The shunt has a synthetic ruby in the top of it to keep it from getting clogged at the top. Near the bottom are slit valves coated in graphite, because graphite doesn't allow anything to stick to it. So, if the bottom gets clogged, the slits open and the CSF can continue to drain.

The evening ended with the community meeting which is pretty much a church service. The first speaker was talking about an organization she discovered in Sierra Leone. It provides training and computer classes for the locals. In particular, the organization is working with 80 women who were abused during the civil war. They were raped, forced into marriages, and were subjected to human trafficking. They are training them to sew and cook in European and African styles so they may work in a restaurant or open their own. The men take computer classes. I was so encouraged to see an organization that is actually addressing the real problems here. They so desperately need education and training and jobs. They took an offering for the organization to which I gladly gave. We got ice cream after the meeting! The first dessert we have had (they do not serve dessert with meals onboard the ship) since we arrived. :) The little things have really made a difference. Mom was in heaven.

As we were driving home, we left via 'Bad Boy Way.' It is where all of the 'bad boys' hang out and smoke and drink. Animals are treated very cruelly here and dogs roam the streets everywhere. The locals tend to abuse them because they bite; however, they bite because most are rabid because they don't vaccinate them. It is really sad. Anyways, as we were driving, one of the bad boys shooed a dog out of his way and the dog ran right in front of us. Dulce hit the dog and killed it. She felt terrible. The bad boys immediately started freaking out and yelling at us. One actually picked up the dead dog by his leg and ran towards us with it. He just stood there holding the dead dog. She stopped the car (seriously) and then rolled down the window (seriously - she is crazy brave). We were all pretty much freaking out that she not only stopped but also rolled down the window! We immediately had 10 or so bad boys surrounding the truck and one was yelling at her that she just killed his dog. Since hardly anyone actually owns a dog here, she figured he was lying. She kept apologizing to him anyways and he kept insisting that she killed his dog. She told him there was nothing she could do about it and it was an accident. When she finally said, "I'm sorry" in Creole, he backed off. Many times the locals lie about things like that because they want money. He was just trying to see if she would offer him money. Crazy.

We got back to the hostel and at the main door there was a frog about the size of a quarter. Dulce freaked out. Apparently she can drive through the craziest place in the world and she isn't afraid to confront the bad boys, but she is scared of a quarter sized frog. Go figure...

That's it for day 5! 

Ethan - I miss you very much! I love you! I think about you every day and am so thankful you are safe in Texas. I can't wait to see you when I get back!