Ludwig’s Angina my nursing report read as a diagnosis for the patient in D1. I gulped, “angina, means chest pain, I am not a cardiac nurse. I didn’t think we did cardiac surgeries on the ship. I have no idea how to care for this patient,” I thought to myself. I can picture that first shift on D Ward, Deck 3, in the hospital on the Africa Mercy, like it was yesterday. Yet, it was 17 years ago in April 2008! I had been a nurse for just over 2 years, the minimum years of experience required for a nurse on the ward aboard the Africa Mercy. That diagnosis for my first patient ever in Africa was the beginning of many “firsts.” Conditions I had never heard about or ever were even discussed in Canadian nursing school. Yes, I am American, but my nursing degree is from Canada. The vast sea of medical conditions to cover cannot be covered in a four year nursing degree. Nor would we focus on diseases and conditions we were unlikely to see. Diseases of poverty, tropical diseases, and diseases simply caused by lack of access to medical care.
I went on to learn that Ludwig’s Angina had nothing to do with cardiac concerns or chest pain. According to the Cleveland Clinic, Ludwig’s Angina is a bacterial infection that starts in the mouth. It is a fast spreading cellular infection that makes it hard to breathe. It is a life threatening emergency. It causes swelling in the tongue, throat, and face. It often originates from an untreated tooth infection. My patient had a bandage wrapped around his face from chin to forehead. He had 9 small drains in his face, constantly leaking pus, and requiring frequent bandage changes. I had never seen anything like it! All his suffering was from a lack of access to care and a dentist. His toothache could have suffocated him and taken his life if it hadn’t been for Mercy Ships.
17 years later I found myself on D Ward, Deck 3, in the Africa Mercy hospital again for my first nursing shift as a ward nurse. D Ward remains the maxilla facial ward and I couldn’t have been happier to land there, in the middle of cleft lip and palate surgeries! Cleft lip babies are my absolute favorite. Well, club feet babies are pretty adorable as well. Make that ALL the babies are adorable, but back to the cleft babies. Their smiles before their lips are fixed are priceless and huge! Each bed was filled with an adorable patient. Some patients were waiting for surgery, happily driving little bikes, in their tiny hospital gowns, down the hallway waiting for their turn for surgery. Other patients were sleepy in bed post surgery with newly stitched up lips. A few post-palate repair patients were crying because they wanted to eat rice and they are not allowed rice for a few weeks to protect the surgical site from infection if a piece of rice got stuck in the palate. We even had a few adults that never had access to care in their many years and were finally receiving cleft lip surgery. See this link https://www.mercyships.org/eta-cleft-care/ for stories and a video from our incredible communication team. The very surgeon in this video from 2016 is the surgeon currently operating on board. Some of the interpreters in the video are my current interpreters. Some of the footage was filmed in D-Ward! I hope to get some photos of me with my patients, but photo policy has changed over the years.
An absolute beauty of a little girl, maybe 3 years in age stared at me with deep brown eyes. She was wearing a puffy pink princess dress. She had a cleft palate repair a few days prior. She was getting ready for discharge. Her curly hair was in two puff ball ponytails on either side of her head. The interpreters joked that her name was Moana, like the Disney character. She also just happened to be coloring a Moana coloring page. The Malagasy people have ancestral roots that are a blend of Southeast Asian and East African origins. Leaving some with a dark chocolate brown skin completion, others with cappuccino colored skin, some a light caramel color. They are all uniquely beautiful! This little girl had the complexion and dark brown eyes like Moana. She was a doll and my world felt complete to hold her in my arms.
I heard the interpreters yell, “Marche, Marche,” in French, which means “Walk, Walk.” The patients got out of bed and joined the nurses, interpreters, and their family member-caregivers in the hallway as the song “Waka Waka, This Time for Africa” by Shakira blared on the speaker one of the nurses held in her hands. Everyone danced and marched rhythmically down the hall. It was exercise time! No better physical therapy and blood clot prevention post surgery than to dance down the hallway together! I smiled ear to ear. I am out of shape and still have zero rhythm. I hadn’t heard this song since 2013 when I left Africa. The patients still love it. We walked back and forth, up and down the hall for around 5 songs. The goiter-thyroid surgery patients joined us from A Ward and walked with us. They are smiling despite having stitches and steri-strips around their necklines where goiters, once the size of huge mangos, melons, or even the size of American footballs filled their neck space, suffocating them as they lay down. Goiters are caused by a lack of iodine in the diet, chronic malnutrition in the diet, and effects from cassava, one of the main dietary staples in these regions, among other things.
As if my memories made the song play, “I Like to Move it” from the Madagascar movie came on the speaker. I just smiled. Apparently, it was still a patient favorite, too. The deck department hotel engineer from the Philippines joined our dancing group as he passed through the hallway completing his duties. The hospital director from Holland-the Netherlands, who was my hospital director on the ship from 2011-2013 and just returned to volunteer with his wife, popped out of his office and danced a few steps with us on his way to a meeting. The eye team leader from Sweden, who happens to be my dear friend that I met in 2008, carefully walked a patient with eye bandages from the OR to the eye room where they would recover from cataract surgery. Out of breath, we made it back to the ward from our Marche, Marche and carried on with the shift. How thankful I am to be back onboard. This place is amazing.
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