24 February 2008

Potpourri for $200

President Ellen Johnson-Sirleaf's visit to the Africa Mercy:

Monrovia from a car window:

Click on the pictures for more

The cleft and the high priest

Evidently, there are rumors about the ship.

Don't go onto the big white ship, people are cautioned. They'll tell you it's a hospital, but it's not. It's a slave ship. You'll get on, and you won't get off.


On that ship, they take you into a special room, undress you, and lay you on an altar. The priest then puts on his ceremonial robes, and you go into a trance. Then they cut you.

For a culture like ours, in which nothing is assigned any religious, spiritual, historic, or supernatural weight, hearing this description of what happens in an operating room (which, quite honestly, isn't that far from the truth) was revealing.

Despite these warnings, patients have swallowed their trepidation and started boarding the big, white, square piece of floating metal. And this is more revealing: if patients are really hearing these sorts of warnings from their elders, there must be a degree of desperation that trumps any fear, any magic, and any possibility that they will be whisked away into servitude. To my mind, it's simply unthinkable that the last possibility—of lifelong slavery, of the reopening of ancestral wounds—is better than what they're facing now. But evidently it is.

Surgeries began on Thursday, and the hospital is up in full swing. One of our first patients was a nineteen-year-old boy named Emmanuel.* Emmanuel had an incomplete cleft lip—nothing drastic, really. Not even tug-at-your-heartstrings, media-worthy. His wasn't at all the cleft lip you'll see on any fund-raising brochure.

For Emmanuel, though, this cleft represented a wall, a distinction from his peers, a separation from the outside world, and an incarnate command from higher powers to retreat into isolation. When we saw him on screening day, he had already spent nineteen years obeying this flesh-and-blood mandate. He was withdrawn. But on Thursday, Emmanuel had his cleft repaired.

Now, I refuse to make far-reaching claims of how much his life could potentially change from this half-hour operation. They're cheapening, and you've heard them all before. Besides, Emmanuel is still a quiet, shy, withdrawn boy, keeping to his corner of the ward. But, let me tell you this:

At church today, Emmanuel was the one playing the drums.

*You'll forgive me, I hope, for not posting too many patients' pictures on this site. It's an attempt at preserving dignity and avoiding exploitation.

19 February 2008

What happened at the stadium

Where you live should not decide whether you live or whether you die.

So wrote a certain Irishman with a penchant for sunglasses (and occasional fits of self-aggrandizement). Unfortunately, he was wrong. It does.

Let me tell you a story.

Yesterday was screening day, the kick-off to this year's outreach, and a day we had all been looking forward to with excitement, with fear, and with a certain measure of trembling. As our caravan of white four-wheel-drives left the Africa Mercy, it transported four hundred souls bent on doing good. Watching this line of cars, emblazoned with the green-and-blue Mercy Ships logo, negotiate the pre-dawn darkness of Monrovia, and knowing that each one moved with a single, united purpose, was profoundly inspiring.

I think few of us were prepared for the intensity of what was to come. The line that met us outside the Samuel Kanyon Doe stadium snaked across the parking lot. I don't know the official numbers yet, but it looked like thousands. And, as the day wore on, it felt like thousands, too.

In the midst of those thousands, in the heat of the day, Michael showed up. He sat down at my table, having passed through multiple layers of pre-screening, a twenty-two-year-old man in the prime of his health. We shook hands, in good Liberian fashion (one day I'm going to write a post about the Liberian handshake. But not today), and he began to tell me about these annoying knots that had appeared on the left side of his neck. They'd been there for four months. They weren't really hurting him, but they were getting bigger. People were starting to talk. He hadn't lost any weight, hadn't noticed any fevers. He didn't smoke, didn't drink, didn't do drugs. Instead, he spent his time studying. We talked a bit about his studies, his family, and then we got down to examining.

Under my fingers, the knots in Michael's neck weren't shy. They weren't large, but they were palpably, inexorably there. A collection of lymph nodes, scattered. And under the pathologist's microscope, they became downright exhibitionistic. This young man had Hodgkin disease.

Now, here's the problem: In the US, this disease is eminently curable. In its early stages, it frankly flees under the ministrations of a four-drug chemotherapy regimen and some radiation. Nine out of ten times. And even for the most advanced stages, nearly two-thirds of patients are still alive at five years. This is one of those cancers you can scare off with a sidelong glance.

In Liberia, though, it's a death sentence.

There is no radiation therapy in the country. And the four drugs in the regimen (first described in the US thirty years ago) still aren't available here. The best chance you have is to get yourself to the one hospital in Ghana, 650 miles away, where, for something like $6000 of your own money, you have a chance (and only a chance) at treatment. For a full course of oncologic therapy, $6000 seems like a steal by North American standards. But for a country whose per capita GDP is $195 per year, that represents a whole lot of money. It's the equivalent of asking any one of us to pay $1.3 million.

Or die.

I hate to be melodramatic about this, but I've got to admit...this was hard news to break. This is injustice, pure and simple.

As I write, our palliative care team is pulling as many strings as they know to get him up to Accra, and in to treatment. The fact remains, though—if they can't, a young man will die from a tremendously curable disease. Simply because he was born in the wrong place. There, but for the grace...

I realize that I'm focusing on one patient, with a less-than-optimal story. There are many stories of hope, many patients we have been able to offer surgery to, many whose lives will—God willing—change because of the work of the ship here in the next ten months. Two friends have written eloquently about Abraham, one such boy.

But, it's the ones whom we had to turn away that have been leaning heavy.

As another has written:

Sometimes when I lose my grip
I wonder what to make of heaven;
All the times I thought to reach up
All the times I had to give.

Babies underneath their beds,
Hospitals that cannot treat
All the wounds that money causes,
All the comforts of cathedrals.

All the cries of thirsty children—
This is our inheritance.
All the rage of watching mothers—
This is our greatest offence.

16 February 2008

Appearances can be deceiving

Perhaps we have been travelling too long. We finally made it into downtown Monrovia today. Sometimes seeing too many things makes you stop paying attention to the details. The city looked poor, but not war torn. Yes, there was trash lying in the gutters, people selling things out of baskets, and potholes determined to rattle your teeth. But at least the roads are paved. There was also a store selling Dell computers, another one called "Radio Shack," and the "Heineken store" selling Frosted Flakes, Lipton Peach Iced tea, and Splenda. Really, if you ignored the occasional UN vehicle and the abundance of barbed wire, how was this different from another third world country such as India?

On closer examination, however, I realized that there was not a traffic light in sight. There is no running water, and so people were washing, cooking, and chopping with big plastic jugs next to them. There's no clear sewage system, nor garbage collection. Once you wandered off the main streets, you saw narrow alleys being co-opted as trash collection grounds. Most buildings were 1 or 2 storied, and the taller ones were abandoned and missing panes of glass. And if you read the billboards carefully you would find, amongst the ones advertising KLIM milk powder and Lonestar Cell, others proclaiming, "Woman is not your enemy, she is your friend," and "Raped? Get free treatment now!" Several posts on the island between incoming and outbound traffic still stand riddled with bullet holes.

In this all we met Liberians who were playing spirited games of checkers, some friendly enough to say hello, and all polite enough to leave you alone if you did not want to buy their wares. This is a testament to the ability of the Liberians to endure, but it also is giving us a false sense of security. Yesterday, Dr. Gary Parker gave us his take on the situation. Imagine, he said, that you are the father of a 5-year-old girl whose legs have been amputated by the rebels during the war. Imagine that you know, through the Truth and Reconciliation Commission of Liberia, that the man who did this to your daughter lives just down the street. Now you need to keep smiling at him every day because if you don't and chaos erupts, the Western NGOs will pull out, and the faucet of aid will be turned off. So every day you grit your teeth and continue to greet your neighbor civilly, but deep down inside every time you see him you want to kill this man. How many of the people we met today have this story? How do you move forward from this history? Would it take just one riot to make being Americo-Liberian or local, Krahn or Mandigo, mean the difference between life or death, able-bodied or a one-armed amputee?

I cannot imagine how forgiveness can occur in this country if it is to be done by human intervention alone.

The rest of the pictures are here.

15 February 2008

Impatient anticipation

There is a palpable sense of pre-Christmas anticipation on this ship, especially among the forty-odd of us who have arrived this week. Today marks our one-week anniversary on the African Mercy. Most of us are no longer seasick, we've been oriented to death, and we're ready. Ready to get our feet wet, our hands dirty, and get started doing the things we've come here for. The anticipation is almost impatient.

Meanwhile, in the midst of orientations and preparations, we're filling our time with dockside walks and soccer games against the Ghanaian UN forces (they won).

But that all changes on Monday.

We meet our first patients in a stadium.

By the way: this ship, the Blue Atlantic, is docked right next to ours. It has an interesting story.

12 February 2008

The Africa Mercy

This post will be short (Crazy, I know...Africa must be doing something to my brain). I just wanted to write a bit about the ship we're on, because that's predominantly what our life centers around at this point. Since patient care doesn't start till Monday, this week has been more about learning to live on board this ship.

The Africa Mercy is the largest non-military floating hospital in the world. And it's big. It weighs 16,572 tons, is 499 feet long, stands eight decks tall, and has enough bed space for 484 crew. To put this in perspective, the largest Staten Island Ferry is 310 feet long, weighing weighs 3,300 gross tons, and the largest ferry plying the Puget Sound is 460 feet long.

The hospital itself is even more impressive. It has 75 beds, a five-bed ICU (including two isolation rooms), an eight-bed recovery room, six operating theaters, a fully functional CT scanner, X-ray machine, and C-arm, and a full formulary, dental clinic, and laboratory. What's most unbelievable in that list of accolades, though, is the equiment itself. You would be blown away by how state-of-the-art some of the stuff in this hospital is: I worked with microscopes much worse than this in residency. And that CT scanner is the only one in Liberia, we're told, and one of only three in all of West Africa.

Quite honestly, the hospital facilities on this ship are impressive. And, so, as promised, here are a few pictures. I'll admit: I'm embarrassed at how unartistic and—well—boring they are, but they do the job. I promise better ones next time.

I told you it'd be short...

10 February 2008

A foray into Monrovia

The Africa Mercy is an incongruity. In truth, we're not roughing it here. The ship is new, the cabins are nice, the people are great, and there's even a Starbucks on board (the coffee mavens graciously donate their bean to the ship to keep us happy). Sure, the ship persistently rocks, ever so slightly, wreaking havoc on your semicircular canals and making you seasick even in your dreams. Sure, the food is—um—cafeteria-style. And windows are few and far-between on the floor we're bunking in. But life on this ship is not bad at all. (In fact, here are a few pictures of life on board. More—as well as pictures of the hospital—coming with the next post).

And it's nothing compared with the world outside. The ravages of war are evident everywhere.

A late-night arrival on Friday (after a turbulence-ridden plane ride from Abidjan, straight through a thunderstorm, with cliff-hanging hundred-foot plummets. I'm not making that up) didn't deter us from venturing off the ship on Saturday afternoon in an attempt to make it into the city.

We failed.

See, the city is a 4km walk away from the ship, and, on the advice of two other Mercy Ships veterans whom we ran into, we decided to take a cab. I use that word loosely. The cars are painted yellow, but that's where their resemblance to anything cab-like ends. They little more than pieces of metal, held together by a few well-placed prayers, crammed with more people than even India would find normal, and driven with reckless abandon. And they will not, by any means, pick up foreigners. At least, not for any sort of reasonable price.

So, we stood, flagged down hundreds of cabs, walked about halfway into town, and gave up. On our way back, though, it hit us where we were, what we were doing. This isn't usual travel; this is nothing like any other place we've been to this year. Or this life.

The ravages of war are evident everywhere.

On our way back, we were almost run over (purposely?) by a man driving way too fast, in the gravel gutter off the side of the road. Though, given the state of his car, I'm not sure which one of us would have suffered more from the encounter.

On our way back, it became real. You know those baby-blue helmets you see the UN forces wearing on the news? They're not made up.

And for some reason, it was seeing those baby-blue helmets that made it all sink in. We're in Liberia, a country that's so poor, it doesn't even make the UN's Human Development Index. We're in a country where the UN is more than a cement-and-steel swoop of a high-rise a few blocks away from us, where NGOs are realities of life, where people still carry automatic weapons. We're in a country whose bombed-out shells of buildings far surpass anything I ever saw in Lebanon. And we're here until June.

Today, though, was different. Today, we made it into town for church.

The ravages of war may be evident everywhere, but so is resilience.

We are Fine-O

Here we are. After a mind-numbing series of flights, we have finally arrived in Monrovia, Liberia.

The first thing that hit me was the smell. In a good way. As we stepped off the plane and onto the shuttle bus, I was hit with a solid whiff of rainforest. Clearing immigration was a chaotic jumble as people jostled their way to one of two wooden desks to have their passports stamped. And then we huddled for a long while in a holding area waiting to collect our bags from a makeshift tent.

In truth, this has been one of the easiest border crossings we have made this year. 30 other crew members were on the flight with us, and due to the good repute of Mercy Ships, we were waved quickly through customs. We were transported from the aiport to the dock by a team of staff members, and were ushered up the gangplank to the Africa Mercy where a hot meal and clean sheets awaited us. We slept knowing that the blue helmeted UNMIL soldiers were out there to keep us safe.

The next few days for us will be about figuring out our role here. Transitioning from tourist to employee of a NGO is going to be tricky. Do we bargain with the locals, and if so, how hard? Do we wear our ID badges when we go into town? Who is a tout and who is just being friendly? Then there is sorting out how it is to live in close quarters with your work colleagues. Perhaps one of the reasons New York holds such an attraction for us is the comforting anonymity the city bestows. Here solitude seem impossible. However, the strong sense of community has been a true blessing. We've met kindred spirits frank and sincere, all ready to "spend ourselves in behalf of the hungry and satisfy the needs of the oppressed..."

We are approaching our approaching our uncertainties with an open mind. Up until now, life has encouraged us only to ask the question, "What do I want?" Here, part of what we have to learn is how to submit to the needs of others. Whether what is needed is something as mundane as scrubbing floors or as exotic as diagnosing cerebral malaria, we want to approach our work here with equal joy and enthusiasm. Perhaps what stood out to us in our short time here is the number of volunteers who have given up lucrative and prestigious jobs back home to work as support staff here, whether it be in the cafeteria or maintenance. May we also have their humility as we face the days ahead.

06 February 2008

Anonymity and cheese-grease

It's not horribly difficult to figure out where our affinities lie when you read this blog--we don't do a tremendously good job of hiding them (not that hiding them is our intent). So, it probably comes as no surprise that this last week in the city has been tonic to our travelled souls. Scary that an agglomeration of concrete, trash, and people too cool for their own good should serve as tonic, but it does.

The week has been an ocean of sushi consumed with wanton disregard for its heavy-metal affinities, thin-crust pizza folded in half and eaten while still dripping cheese-grease, overcrowded and broken-down subways (one might wonder if the A will ever actually work like it's supposed to--were one inclined to wonder about such things), soft-boiled eggs done just like they're meant to be, text message flurries, the arcana of Super Tuesday's contests, trips to Duane Reade, and meals with friends we haven't seen for months and will not likely see for many months to come.

But more than that, this week has been a whirlwind of anonymity, of being able to walk down streets that pulse, even at two in the morning, with life, and grab a salad. And feel safe. For those of us enculturated into the individualism that defines our generation, that kind of anonymity is a balm we're likely not to get on the ship. New York offers something that many places we've seen, been to, and lived in do not: a sense of oxymoronic, anonymous community, foisted upon you simply by dint of the fact that you are surrounded by the masses of the mostly-washed. This is the sort of city in which the lives of others unfold, naked and often lubricious, in the middle of the street. This is the sort of city in which a McCain supporter and a Hillary campaigner can get into a heated altercation in the middle of a public square and be left unperturbed by the rest of us. This is the sort of city in which, because you're surrounded by the lives of others, you can feel like you're part of something. Even without being part of something. This is anonymous community.

This is New York as a cop out.

But, it would be disingenuous to claim that we don't love it here, that this doesn't feel like home, that, in the midst of friends constantly in flux, of people who walk and talk way too fast, we don't feel unabashedly like this is exactly where we belong. Because, underneath the teeming city, shaded from the lives of others, community--real communinty--does end up happening. Real groups of like-minded friends emerge, and that, almost effortlessly. After all, New Yorkers (all evidence to the contrary notwithstanding) are nice.

And this is what we leave tomorrow. To join the crazy doctors and crazy Christians (to use the New York Times' phrase) in Liberia.