My time on Mercy Ships is coming to an end! It's with mixed emotions that I leave tomorrow- I will miss the friends I've made on the ship and having someone cook/do the dishes for me, but am excited to be back in the US and see family and friends and start my new job in Boston!

This week has been full of discharging patients after their multi-week stay on the ship. It's been really exciting to see the changes as their post-op dressings get smaller and smaller and their wounds heal. I'm glad the timing of my services allowed me to be here most of their admission- allowing me to see before and after! While the nursing work wasn't always the most challenging/exciting, I really have enjoyed getting to know the kids, their caregivers and the other staff. This week I was on night shift, which are particularly slow. Myself and the two other nurses working spent a good chunk of the shift sitting out in the hall playing cards and chatting with the night housekeeping crew. They are Senegalese and we were telling them how much we enjoy the communal nature of the wards. They could not believe that hospital patients in the US have their own rooms and don't talk with the other patients. They were shocked that you could go to the hospital and not meet other people!! It's definitely gonna be different when I go back!

Some final pictures from my time on the AFM:

The little fishing boats around the port

This is Goree Island, we can see it from the ship. We took the ferry out, it used to have all the slave houses where they would wait until they were sent over

George Floyd's portrait is on Goree Island

Bingo!

 Well the lice situation seems to be under control. I had to do double takes of all the boys when I came on shift last night because most of them had their heads shaved yesterday while I was off 😆 It took me a minute to work out who was who!

We (the surgeons I should say) have finished all the scheduled plastic surgeries! So now I am mostly taking care of the kiddos as they wait to recover/let the skin grafts heal. It's pretty low key nursing- mostly making sure they have the right nutrition to improve wound healing. Every day we mix up a peanut butter drink with milk called Mana and they have to drink four cups a day. It kindof tastes like a peanut butter smoothie, so it's not terrible, but after 3 weeks of it, they are starting to get a little sick of it!

One of the favorite ward activities is to play bingo! I got the honor of being the bingo master last night. We call out the numbers in French, so it was good practice for me! The kids and especially their caregivers were very into the game. I introduced blackout bingo which was a little hard to explain (I couldn't find the translator at the time) but they eventually understood we were playing to cover the whole card. The rest of the time everyone just hangs out socializing or sitting around the computer screen watching cartoons.

More pictures!!

I've been able to get off ship quite a bit (a few times a week for at least a couple hours) and explore some of Dakar. Highlights include going to the fabric market, taking a surfing lesson, checking out a small island off the coast (Ngor Island), scrambling around on the rocks by the beach. Here are a bunch of pictures:

boat ride out to Ngor island- good thing we had life jackets- the boat was very full!

Getting the water out of the ship after the ride!!

the streets stay flooded in the rainy season because there isn't any drainage

views around Ngor Island, no cars, just walking paths

fabric market

surf lessons

guys walk around with nail clippers/scissors/files and try to sell you a pedicure- don't think i'm gonna try it!

fish and chips

these vans drive around with the back doors open so people can hop on/off as they are driving around (on the highway!)

our night off the ship- we only saw one roach at the hotel 😂

little rock paths to hop across the street

there's a wide range in how nice the buildings are around town, these two were right next to each other

it was a hot and sweaty taxi ride and our driver could barely see because his windows were so fogged up and he was still driving crazy on flooded streets- the closest I've come to thinking I might die- but we made it!

More of the same in this google album:

Senegal google album

 We had a "Spa Day" on the ward yesterday. It was discovered that a bunch of patients had lice, so we had to treat all the patients and their caregivers with lice shampoo, which required every females to remove all the braids from their hair... quite the process! Despite them being a little self conscious about taking their hair out (not everyone was thrilled about rocking an Afro while their hair got shampooed and combed out), or bummed because their hair took hours to braid, they all did it without complaining, and of course everyone helped each other out. I just think about how much complaining/resisting there would have been if we were in the same situation in the states! Who knows, maybe they were complaining and I just couldn't understand them because it was in Wolof!! Either way it made for a much busier shift and lots of laundry for the crew. We've now had a covid, GI and lice outbreak since I've been on board the AFM. Thankfully I've managed to dodge them all and hopefully that's the end of it! Gotta love the ship life!

In other news, my bunk mate and I got to switch to a slightly larger berth in our cabin, we have about an extra 5 square ft, which almost doubles our floor space- moving up in the world! We got a new cabin mate who is a Dutch nurse and getting a 5th person, a woman from Sierra Leone. Should be fun!

 I'm just over half way through my time on the Africa Mercy. Time was moving really slowly at first, but now it seems like it's flying by! I think that's partly because the wards are much busier these days. I'm still taking care of patients after their reconstructive plastic surgery and really enjoying it! It's mostly pediatric patients, which mean the ward is much livelier now! In general the patients feel crummy for the first two days after surgery and require more nursing interventions (lots of pain meds, assistance toileting/repositioning as they usually are on bed rest for a couple days, learning how to use crutches while they are in a cast, NG feeds to improve their nutrition and help with wound healing, dressing changes). But once they are a little further out from surgery and more independent, it lots of hanging out playing Uno, making friendship bracelets, coloring or like last night, I walked into another ward and everyone was sitting around the computer watching a movie! It's a good mix of having some busier and more chill days. The first block of patients mostly came and went within two days of their surgery, but we have yet to send a plastics patient home, so they've all been here at least two weeks and it's fun to get to know them! I'm looking forward to the next couple weeks as we start to remove their casts/dressings and see the transformation that's happened!

The ward is so different than the US in that it is waaaaay more communal. While I assume this is partly because the patients don't have their own rooms (we have 6-8 beds in a ward plus their care givers sleeping below), it's more than that. Each morning everyone goes around to each other's bed and greets everyone. Taking the time to greet someone correctly is a very important part of Senegalese culture. I often have trouble working out which caregiver is with which patient because anyone will pick up a baby who is crying (not just the mother) or help someone to the bathroom or discipline a child who is misbehaving. I love the way they look out for each other!

It's good that the ward is so lively because unfortunately it's on a lower deck so there are no windows. It's weird working all day and having no idea what the weather is like! I can't imagine what this is like for our patients. We do take the whole ward up to an upper deck once a day for an hour so they get some time outside. We go from 2:30-3:30pm, so by the end, all the nurses who aren't used to this weather are hot and sweaty! But the patients and families seem to enjoy it- someone will start playing music and all the women get up to dance- maybe one of these days I'll join in!!

some random photos:

The ship pool

The fun part is when the ship is rocking, you get some good waves in the pool!

evening volley ball on the dock

this is at the end of the pier, they are storage containers that act as lockers for all the guys working to unload all the supplies from the ship

eggs being lifted onto the ship

On the AFM, there are medical staff from all over the world. While the ship operates in English, one of the fun parts of being in the hospital is working out all the regional terms and abbreviations staff use in their charting! It's an extra little puzzle- in addition to trying to decipher the hand writing, you get to solve for the term/abbreviation! One nurse from London commented that she likes working with American nurses because we all speak just like the shows on TV, using phrases that she's heard on shows like ER and Grey's Anatomy. I guess other countries don't say STAT, that's an American thing to do, they will write it in orders, but don't say it aloud. For all my medical friends, here's a list of some of the terms I've seen, see if you can guess them!

NBM .................... Nothing by mouth (our version of NPO)

Group and Hold ....................  Type and Cross

Cannula .................... V ("I placed a cannula")

Observations .................... Vital signs (a US nurse had paged a doc about a patient who was having some problems, he asked her for the observations and she started describing what she was observing on the patient, he kept asking for the observations- it took a moment to realize he meant vital signs!)

Theater .................... Operating Room 

BNO/BWO .................... Bowels Not Open/Bowels Well Open (they have or have not pooped)

BM .................... Blood monitoring, which is what the British call a glucose check, but for us means a bowel movement!

Black Wednesday .................... The day the new residents start in England, the first Wednesday in August, our equivalent is July 1st. Turns out not wanting to go to the hospital the day the new docs start is universal!

Paracetamol daily 2/52 .................... Take Acetaminophen daily for 2 weeks, they will also say 3/7 (3 days) or 1/12 (one month)

 Hello all! I just finished my first stretch of night shifts (I'll have another one before I go) and the hospital is definitely busier! We have two ORs running and enough patients to fill two wards. I'm assigned to the ward that mostly takes of the patients after their reconstructive plastic surgery. Most of them are children who had some sort of burn which did not heal properly, so their scarred skin makes it difficult or impossible to move the affected joint. Reading their charts, it hurts my heart how long they have been living with this condition (years and years). Most of these patients were screened back in December, so they have been anticipating this for months! Their surgeries usually require skin grafts and take weeks to heal, which means they will be on the ship for awhile. It will be fun to get to know them, especially now that I'll be back on day shift and not waking them up all night!

Here is a picture of the ward after we finished cleaning it last week! Each ward can hold 12 patients. Note that the beds are on little risers- that's so the care giver can sleep on a mattress under the bed. If you need a parent during the night, you have to duck down under the bed to wake them up! A couple times I've been looking for my patient and realized they were asleep on the floor next to their care giver (I'm guessing that's probably closer to their sleeping situation at home). Our plastics patients are higher risk for infection and will need to stay in the bed, so that won't be happening as much now!

 It's been another slow week on the ward, we still only had one OR running, but I'm told it's gonna get busier starting this week! A plastic surgeon arrived on ship today, so I will start taking care of kids who require skin grafts due to burns or other issues. I'm excited to see a new type of patient and be a little busier!

The highlight of the weekend was I got a full tour of the ship. One of the deck crew took me around. We walked the whole ship- bow to stern on each deck (note my nautical language!). It took about 25 minutes! The tour ended in the engine room and the engineer on duty proceeded to give me a tour of all the inner workings of the ship! It was a spur of the moment tour, but they were very welcoming- a common theme I've found in Africa. Even if it's an imposition, they will go out of their way to welcome you/help you with what you need.

they had me pretend to do work!

more pretending

It was very hot and noisy down in the engine room!

me and the engineer on duty

  Let's see, here are some other random things from the week...

I sat one evening watching these guys pull in fish with this huge net

it was neat because you could hear them singing the whole time to keep them working in sync

The ship got some pet birds! I guess vendors cram lots of birds into a small cage and sell the birds for people to make a wish on. They often break their wings so they get eaten by cats when they are released. This didn't sit well with the crew so they bought 29 of them and built a cage for them on the ship

the mean dock cats 😂 they are everywhere!