Sunday, 4 December 2011

Christmas in Africa

This weekend 3 friends and I went away for the final time in Sierra Leone.  This morning as I sat in glorious sunshine having breakfast with the palm trees gently swaying in the warm breeze I suddenly heard the distant strains of 'O Come All Ye Faithful' being sung in a local church.  As the sound drifted towards me through the lush vegetation I got to thinking how strange it is to think of celebrating Christmas in a tropical climate.  But so many people in the world do.

We all have our Christmas traditions.  For me it is fires, mulled wine, candle light and long walks in the cold wintry air.  For others it is presents, for many it is that slightly nauseous feeling that comes from having eaten too much.  But these are just things.  Being in a place where the senses are not overwhelmed by commercialism, bright lights and the buy, buy, buy culture of the Western Christmases makes me realise not how lucky we are but how blinded we are by our ever growing need for...stuff.

Now I am in a place where the frantic rush to attract the attention of consumers does not begin in October and this makes for some serious reflection.  In a place where people have nothing but their voices to celebrate the birth of our Saviour, the simplicity and joy of people's faith becomes all that matters. 

Where we are blinded by our consumerist need, the people here live by blind faith.  They follow and praise God with a deep joy despite their circumstances.  They think nothing of spending hours in a hot church singing and dancing praises to the Lord.  When they have nothing, God is enough.

God should be enough for us all this Christmas but for many (including Christians) he isn't.  When we are safely ensconced in our houses surrounded by all we could possibly want, the people here will continue to sing praises despite their circumstances and not having what they need.

As I was listening to the carol singing, I read these verses from 1 Peter 1:6-9:

'6 In all this you greatly rejoice, though now for a little while you may have had to suffer grief in all kinds of trials. 7 These have come so that the proven genuineness of your faith—of greater worth than gold, which perishes even though refined by fire—may result in praise, glory and honour when Jesus Christ is revealed. 8 Though you have not seen him, you love him; and even though you do not see him now, you believe in him and are filled with an inexpressible and glorious joy, 9 for you are receiving the end result of your faith, the salvation of your souls.'

As Christians, and like those I have encountered here, we should not dwell on what we don't have.  Maybe this Christmas we should wake up from our food and alcohol induced haze and see that Jesus doesn't owe us that new phone or toy but rather that we owe Jesus our sacrificial lives, even if life isn't quite going the way we want it to.  We should rejoice in Him this Christmas, putting aside all the distractions and the flashing lights and simply thank Him for all things, whether we have what we want or not.  After all, to Him our faith is of greater worth than gold (and presents). 
The Africans get it right when they bring their only gift, the most precious gift of faith to celebrate Christmas.  And that, I think, is a lesson I will be reflecting on for many Christmases to come.

Wednesday, 30 November 2011

Saying goodbyes

Yesterday I wrote a blog.  I can't say it was the best that I've written but it had some information that you may (or may not) have wanted to read.  Anyway as I was finishing up, I deleted the whole thing by accident.  Oh how I did laugh (weep).

So to start again, with the biggest news.  This time in 1 week I will be about to get on a plane to come home.  Yes, 1 week.  How crazy is that?  After 11 months away and almost 15 months with Mercy Ships I am coming home.  How did I make this decision?  The main reason is that I am emotionally and physically exhausted.  I always knew that working through this year without a proper break would be tough, but little did I know.  It has been the most incredibly demanding year with so many ups and downs, so much laughing and so much crying.  I have grown in so many ways that I never imagined.  I prayed about staying with Mercy Ships in another role that was not so emotionally demanding however the more I thought about it the more I realised that there is very little else I would rather be doing here.  And that makes me happy to know that I am right where God wanted me to be.  Being stretched, challenged and pulled in so many different directions but at the same time growing in myself and in Him.

So now God is moving me on.  What to do I am not totally sure yet.  What this year has taught me is to be at peace, to not be anxious about what tomorrow holds.  Who knows if I will get a job straight away but what I do know is His provision.  I have spent the past 20 months without any reliable source of income.  But I have not been short of money once.  Stepping into His provision and out of my own has totally changed my view of money.  When I was earning I had enough but it never seemed to be enough.  Now I have nothing it feels like I have so much.  Isn't that amazing?

As for my work here, things are slowly winding down.  The ship is becoming more and more deserted as more and more people leave.  The hospital closed its doors to the last patients last Friday and now is eerily quiet and deserted.  There is a buzz around to get the ship packed up and ready to sail.  Of course everything that moves has to be tied down which is no mean feat.

And while all the activity flows around us, we continue to say goodbye to our little flock, those we have left in palliative care.  We have 3 patients, all elderly ladies, who we will hand over to the hospice this week.  We have all known it was coming but it is still hard.  We are so blessed to have found The Shepherds Hospice.  The hospice staff are all experienced and well trained in palliative care.  They know all the issues surrounding the patients.  They also know the importance of good symptom control and pain relief.  They are also the only medical facility in Sierra Leone to be able to supply morphine.  Last year it was so hard to leave my patients knowing that there was no one for them to rely on.  This year, I know they are in safe hands.
If you want to know more about the hospice and fund raising efforts, please see the following:,,

I am also trying to finish off the other part of my work, the Burkitts Lymphoma programme (see my earlier blog).  This has definitely been the toughest part of my year.  As with all cancer treatments, some will respond and go in to remission, some won't.  That is the case with my Burkitts kids, despite statistically their chances being higher.  I have sent several children home who appear to have responded to the chemotherapy and are hopefully in remission.  But I have also sent several home having done all we can including 3 little boys in the past 3 weeks.  Two are in the hospital right now.  We have seen it coming for a while of course, seeing their tumour not shrinking as it should, seeing their little bodies become thinner and their bellies bigger (a classic sign of advanced Burkitts).  But it is still a shock both for us and the parents when we have to call a stop to the treatment .  I'm not a paediatric nurse and I never will be.  Developing ways of seeing a child dying in front of you is something I would have never anticipated doing. 

All this would have been easier to cope with if the children lived in Freetown but none of them do.  Burkitts is know to be partly caused by malnutrition and malaria, both of which are extremely common in children from the more remote parts of the country (even more so than in Freetown).  So they all travel from the furthest points of the country to get to us.  If they lived in Freetown we could care for them palliatively, refer them on to the hospice when we are gone and know that they will be comfortable and pain free for the time they have left.  As it is, we can only do what we can and send them home with as much pain relief as we can gather, hoping that it will be enough to last them.  I know that we have done all we can for them.  We have given them some dignity and given the parents some understanding of their condition so that when they return home they will not be rejected and outcast as so many are.  But you know the thing that breaks my heart the most?  That point when, after hearing that their child is dying, the mother will still bless us and thank us for all we have done for them. 

And that is, I think, the best way to sum up why I am here.  Knowing that through what I have done I have bought a little bit of hope and peace to those lives I have been entrusted with.  Even when we have lost the battle my patients and their families have not seen that, they have seen what we have done for them rather than what hasn't.  They take joy in their blessings even when they are being dealt a harsh blow.  That is a lesson that I hope I will carry with me for the rest of my life.   

Friday, 25 November 2011

Adama's Story

Below is a story written by one of the writers on the ship about one of my patients.  I think that it gives a good idea of the other part of our work which is a little more towards social work than nursing!

"The Mercy Ships Palliative Care Program was initiated after crew member Ann Giles identified a need to offer continuing care to people with inoperable tumors. Now in its tenth year, the program sends nurses into the community to offer pain relief, wound care, counseling and support to these patients.

Palliative care and cancer care are still in their infancy in Sierra Leone, and there is very little treatment available at local hospitals. “Often doctors here don’t tell people the truth because there isn’t much they can do to help them anyway,” says Palliative Care Team Leader Harriet Molyneux. The result is that many of the patients with whom the team works have never heard of cancer before. “We have to tell them, ‘This is what cancer is; this is what we can do for you,’” says Harriet.

It is never easy to tell people that they are going to die, but cultural differences between the palliative care nurses and their patients create additional challenges. “In this culture, it is very hard to break bad news to people,” says Harriet. “The culture is very much to say, ‘God is great’ and encourage each other and build each other up. So it’s difficult to say straight out, ‘I’m afraid you’re dying.’ I’ve never said it directly. You couldn’t do that.”

Esther Komba, a palliative care day-worker who has been a practicing nurse in Sierra Leone for over 15 years, has been an invaluable cultural interpreter for the team. “She struggled at first,” says Harriet. “She went home crying every day the first few weeks, because it’s completely going against her culture, but she’s a very strong woman, and she’s stuck with it – she does a fantastic job.”

In 2011, the Palliative Care Team was given a budget to develop income-generating projects for their patients. These projects help patients to support themselves and to be assured that their families will be secure after they die. The team works with patients to identify a skill or trade that they have developed in the past and then helps them to get the materials and training they need to start their business.

Adama Kargbo ran a cooked food business for 20 years before she developed a malignant facial tumor and became too sick to work. She came to Mercy Ships hoping to be healed, but unfortunately her tumor was inoperable. “When we first started with her, she was very depressed, very low,” says Harriet. “She had spent all of her savings on treatments that hadn’t worked, and she was unable to feed her family.”

Adama attends church regularly, and her faith and the support she has received from the Palliative Care Team have helped her to accept her condition. Her cancer is slow-growing, so after visiting her several times, the team asked whether she felt well enough to work. When she expressed a desire to restart her business, the team helped her to get everything that she needed to set up a food stall in the market. “From then, I’ve never slept hungry again,” says Adama.

Now Adama’s business, which she runs with the help of two of her daughters, is thriving. She has added benches inside her stall, and she has also started a second cooked food business that operates five days a week. Having managed to save a bit of money, she plans to start selling dried goods soon. The earnings from her businesses support ten family members and allow her to pay her grandson’s school fees so that he can continue his education.

“It’s dramatically improved her quality of life,” says Harriet. “She’s able to buy food for her family, and it has also improved her emotional state. She’s brighter, she has a lot more purpose. We’ve noticed a big difference in her.”

When the members of the Palliative Care Team arrive for their weekly visits, Adama always has a hot meal ready for them. “I prepare food for them to show them love because they have showed me love,” she says. “They are my family.”

November 2011
Written by Catherine Cooper

Adama outside her foodstall with her daughter Kadiatu and granddaughter 

 With Camilla and Dee, my palliative care team mates

Saturday, 12 November 2011

A birthday present

Today is Esther's birthday.  Yesterday we got her present - a chicken.  The idea for this came from our gift of Clarence (see earlier blog, Clarence and Me) that we received a few weeks ago. Clarence II was duly purchased and presented to Esther.  I'm not sure of her reaction, it was difficult to gauge!  After pooing in the car, Clarence II was dropped off with a friend of Esthers and we continued on with our day.  I never thought I would see the day when purchasing a chicken in a bag would be normal.

Sunday, 6 November 2011

Events are just like buses...

Two blogs in one week, amazing!  Events to write about these days are kind of like buses (in the UK at least) - nothing for ages then they all come along at once.  So enjoy while it lasts!

I thought I should put up some pictures of Princess Anne's visit to the ship even though I was not there (see my last blog) and most of you know what Princess Anne looks like (you know, daughter of the Queen, bouffant hair).  Seriously though it was still a pretty special visit and everyone seemed to be excited to meet her.  The feedback was that she seemed genuinely interested in everyone she met, asking them lots of questions about their work and where they were from.  I think a lifetime of talking to people means she has had a lot of practice.

On the wards with Kirstie (R), the ward manager from the UK

Arriving at the ship to be met by Donovan Palmer, our MD, and his wife Mae

Meeting some of the children in the ships academy (as you can see they were all a little overwhelmed!)

Princesses aside, normal life carries on.  One thing that has been a weekly ritual for us since the beginning is Africana Friday.  According to Esther Friday is the day that people here dress in their glad rags.  Don't ask me why, as she doesn't really know herself.  That's just how it is apparently.  Every Friday for the past 9 months Esther has duly turned up in African garb looking very smart.  As always we complement her and as always she says it's because of Africana day.

Somehow last week the conversation got round to this day and Camilla and I found ourselves agreeing to join in.  And I knew just the thing to wear.  My birthday present from last week (see my blog).  Once I put it on however, vanity stepped in.  Now I don't have the most svelte figure in the world but I like my clothes to not make me feel like I am wearing a sack.  Oh, and I also looked like I was 8 months pregnant.  So a belt was duly added to the ensemble and I was good to go (sadly there was not much that could be done about the puffy sleeves).  So we started our day much to the amusement of my friends and the obvious delight of Isatu, the patient we were visiting that day, and her family.  She also happened to be wearing a Krio dress.  The dress was pronounced a success and I was told I was now a Krio/Sierra Leonean girl which I am taking to be a good thing!

With Isatu

With Camilla and Esther

Living on a ship with 400 people and around 30 different nationalities means you come to learn about many traditions/celebrations from different cultures.  Yesterday was our turn for bonfire night.  Of course, many people were curious as to why we celebrate the 5th November.  When you begin to explain the origins behind it, that we basically celebrate a man being hung for trying to blow up the Houses of Parliament, it begins to make us, well, look just a little bit crazy.  Craziness aside, we started the evening with a BBQ on the dock (for everyone) and one or two people decided to organise a party (for the Brits).  To try and summon up a cold night (not too difficult in air conditioning) people came wearing hats, scarves and gloves.  We played games, ate British food and even had 'fireworks' (from New Year, on the TV).  To top off the evening, we all gathered on the dock for sparklers.  A few, rather bemused, non British crew gathered to watch us all running around waving said sparklers which made us look even more mad.  But somehow, nobody really cared.

The BBQ on the dock

Playing games in mid-ships

The 'guy' (sadly we couldn't burn him!)

Sparkler waving on the dock

Tuesday, 1 November 2011

My Birthday (Week)

There have been numerous times over the last few weeks where I have sat down to write a blog and no inspiration has come.  There should be so many things for me to write about, things which would interest all you out there reading this (if anyone is?!).  When I really reflect on this crazy place that I live in, it certainly is so out of the ordinary.  But it now seems so normal, so mundane to me.  Putting in to words daily life has become somewhat of a challenge so I apologise for the very long time between this blog and the last.

One thing that happened last week that does not happen every just so happened to be my birthday.  On reflection, I think it is the first birthday I have spent out of the UK.  Now I'm not really one for big celebrations choosing instead a quiet night in with friends.  However due to the fact that I am in Africa, on a ship, the usual birthday routine followed quite a different pattern.  Instead of a birthday day it turned in to, well, more of a birthday week.  Maybe people here thought I had planned it that way, maybe I looked like a big egotist, but I had a great time!

It started with my good friend Gemma suggesting that we go away together the weekend before my birthday.  Many of you know Gemma.  We went to Uni together and lived together after graduation.  She came to the ship in 2008 and has been here ever since (in the process meeting and marrying her husband Todd).  It has been such a blessing to have such a close friend here who knows me well.  I probably would not have coped when I first arrived without her!  At home we used to go on regular holidays together so for old times sake we decided to repeat the process but tie in my birthday at the same time.

One of our favourite places to go and stay is on a beach around 1 1/2 hours drive from the ship.  Tourism in Sierra Leone is still in recovery from the civil war so places to stay on the beach are limited.  They are also expensive - anything from $20-$50 per night for a basic beach hut, often with bucket showers, no electricity and no running water.  Florences is the best value for money that I have found with clean rooms, proper bathrooms (!) and great food.  It is also on a quiet river inlet next to the sea so at high tide the water comes right up to the guesthouse.  It's so peaceful and the perfect place to relax.  It was great to spend time catching up, as, despite living and working within a few hundred yards of each other, we rarely get the chance!

Amazing salad and humus lunch

The view from our room

It is a tradition on the ship to decorate the door of someone celebrating their birthday.  On Wednesday morning I stepped in to the corridor to be confronted with the below.  Some of my friends had pooled their photos of me and had managed to get together quite the collection of me in many weird and wonderful poses - I didn't know there were so many out there!  But this was just the beginning.

When I arrived at my desk, I was confronted with this:

When I went to get in to my car that I use every day, I found this:

For those of you who don't know Marge, she is my car.  She was named last year after Margaret Thatcher (of course).  It just so happens that both last and this year I have worked with another British person so we had to have a strong British woman's name.  Margaret was the winner, mostly because the car is a battle axe and an iron lady just like her namesake.

As it was a Wednesday I had continue my usual work routine and patient visits.  On that day I visited Madeleine an indomitable lady of 83 who speaks perfect English and who is quite the character.  As I arrived she produced a present and card which I duly unwrapped and out came this:

This is a traditional Krio dress.  The Krio's are descendants of the original freed slaves who settled in Freetown.  They make up a large percentage of Sierra Leones educated classes.  Madeline is a Krio and as a result wears these dresses on a regular basis.  The white part on the top of the dress is make up of very close together embroidery stitches.  It touched me greatly to receive something which will remind me of my time here.

After visiting Madeline we headed to a cafe in Freetown (probably the only consistently decent place to eat in the city centre).  There I was presented by my workmates with a bunch of flowers (a bit of a joke - the only flowers to be bought here are fake, garishly coloured plastic ones.  I am always commenting on how horrible they are!).

My wonderful team:

After eating lunch a cake was whisked out of a plastic bag along with candles and icing sugar to dust it (in the picture I am trying to blow out the candles in slow motion for the picture, hence the face and Dee's hysteria!).

I felt truly blessed throughout the day and was showered with presents and cards by so many people.  In the evening I gathered some of my closest friends on the ship and we ate together on Deck 7, one of the outside decks on the ship.  Another cake also materialised (thank you Jess if you are reading this!)

It was a wonderfully different birthday which I will remember for a long time.

Oh, I almost forgot that one other small event happened on the ship that day.  Princess Anne, the Princess Royal just so happened to decide to visit (all pre planned of course).  She was in Sierra Leone visiting some charities of whom she is patron and was invited to tour the ship.  None of my team were invited to meet her so we decided to go out for lunch instead and miss the whole event.  Somehow I would much rather spend my birthday with people whose friendships I have come to treasure.  I'm sure Princess Anne didn't mind.

Sunday, 18 September 2011

Amazing gifts

With blogging comes a challenge to constantly be motivated to write new, interesting and witty (!) things.  Most of the time that is difficult especially when living and working in such an abnormal (the ship) and culturally overwhelming (Sierra Leone) environment becomes normal and even mundane.  At the other end even the best writing in the world would not convey half of what I experience.  I am sorry my blogs have slowed up lately but I will try and continue to amuse, entertain and interest you as long as I am in Africa!

One of the most touching things that I experience here is how welcomed I feel by my patients in to their homes and their gratefulness for the little that I do.  This gratefulness often expresses itself in the form of some gift or another.  People give what they can and I am always touched.  Last year I pretty much just received coconuts.  Now don't get me wrong, I really like coconuts.  Just not 1 bag (around 7) a week.  It became a running joke when we returned back to the ship laden with them.  This year has been much more varied (despite still getting several coconuts)!

We have received pineapples and mangoes, sadly only once (I hold out hope for more!).

During corn season we received several bunches.  I love corn on the cob and got stupidly excited about tucking into it.  It is commonly sold here as a street snack, grilled over coals which I was also couldn't wait to try.  But this is Africa where things are never quite how they seem.  The corn here is more like a type of maize.  Which means tough and chewy, despite boiling for at least 1 hour.  It was quite the disappointment.        

Cucumbers have also been a regular feature on the gift list.  We get cucumbers every day on the ship and considering they are one of the few green things we have, I eat them most days.  So to receive extra as a gift is quite something (meaning I never want to see another cucumber again when I get home).

The other day I got something a bit more exciting - several bags of coconut cups.  These are another popular street food which consists of dried coconut and sugar formed into cup shaped crunchy biscuits.  (Photo courtesy of my friend and wonderful photographer, Deb Louden).

So after being given a varied range of fruit and vegetables, my next gift was certainly interesting - a bowl of pap.  Pap is a type of porridge made with ground rice which is very popular.  It can be savoury but the most common way of eating it is sweet with coconut which is the version I was given.  And it was still warm.  Yum.  It caused much curiosity in my office but no one got past one spoonful as it was so sweet and watery with a texture not unlike tapioca.  All I can say is I'm very glad I did not have to eat it in front of the patient that gave it to me.  I tried to give it away to the patients on the wards but none of them wanted it either.  So unfortunately the pap had to be flushed away.

This particular patient was very keen on giving us food.  Our conversations on visiting her generally ended up revolving around food and how to cook particular foods.  She also offered on a regular basis to pack food up for us to take home on the plane despite our remonstrations that we would not get through customs.  She even suggested that the ship should go to London so that her food could be delivered to us!  So it was not a surprise that a couple of weeks after the pap incident we arrived to a bowl of rice and sauce waiting for us to take away.  The sauce was made up of commonly used cassava leaves (almost like spinach), seasoning, the obligatory chilli's ('pepe') and some chicken thrown in for good measure.  It actually came in very useful as we were on course to miss lunch that day so took the opportunity to tuck in in the car.  Esther was especially appreciative and it was pretty difficult to tear her away when we had to go and do a visit!  (Note us being very African and eating out of a communal bowl)

All these gifts have been wonderful and have certainly broadened my experience of the African culture however the best gift was definitely Clarence the chicken (see my earlier blog).  Clarence lived with Esther for a good two weeks after we were given him but now resides in chicken heaven after being thoroughly enjoyed by Esther and her family.  RIP Clarence.

Not only have I been given physical gifts, I have also been given a new (African) name by Esther!  It is common here to be named according to where you were born in the family.  So the first born boy would get one name, the second born a different name and so on.  The same applies to girls.  My new name (being the third born girl) is 'Finda'.  I have also been named 'Lastina', meaning the last born in Krio.  Harriet Finda Lastina Alice Molyneux.  I think it has quite a ring to it.