The Hope Centre

So a quick break from the darkness of Congolese authority and the scourges of leprosy. I have a whole back log of photographs from my time with Mercy Ships in Sierra Leone. I’ll be posting them sporadically throughout the year. Not much writing on this one, just a collection of my favourite photos from the ‘Hope Centre’. This is the off-ship building Mercy Ships uses to house patients that have a long recovery time and need extra therapy or rehabilitation. Everyone is taken very good care of here.

The painted wall mural on the walls outside the Hope Centre from when the Anastasis last visited just after the end of the Civil War.

Patients from Guinea play draughts/checkers the afternoon before they return home.

A young patient sleeps under his mosquito net in an air-conditioned ward in the Hope Centre.

A young cleft lip patient runs past the paintings made by Mercy Ministries group activities which connect non-medical crew to the patients.

Barry and Cheryl Wells run the Health Centre for half of the 24 hour shift.

The Hope Centre building was known in Freetown as Obama City. For some reason Mercy Ships decided to change it’s name…

Denise Miller leads the Mercy Ministries activities on an afternoon.

The Hope Centre is a pretty cheesy name in my opinion, but then I can’t deny that I really enjoyed the visits I had there. I only went a few times, but the hopefulness there smacked you in the face somewhat. If you walked in their off the street, whether you’re from Sierra Leone or the States you would be presented with children and adults with to be quite blunt quite alarming deformities and abnormalities to their faces, bodies and legs. But there is not even a hint of a Victorian Freak show about this place. You very quickly barely notice their physical differences because they are so happy to be there. The predictable cautiousness they have when they first enter the building evaporates within their first day – let alone the fact they are here to have life-changing surgery, they are made to feel loved from the very outset.

It’s what I love about Mercy Ships. It does cost a large amount to run the operation, and it does focus on the individual more than development, and it’s not work that Africa can make sustainable, but then sometimes it can only take one person to make a difference, and when you spend time in places like the Hope Centre you can see for yourself that every bit of effort made by the volunteer crew, and every dollar donated by those in ‘normal’ jobs back home is worth it.

NB – please look at the comments made by Mark Palmer. He is working with various off-ship programs to make sure they do have a long-lasting sustainable role in local development and training, so I take back my comments, apparently my view of Mercy Ships is much more in line with their old model which they are steering away from… excellent news.

A Successful Screening.

Well we had our screening day on Saturday, and it went very smoothly. We had security teams present at the site from 2pm the previous day and there was no trouble at all. Due to the chaos of the last screening three weeks of hard work had been put in to make sure this screening was rigorously planned and efficient. By the end of the day a little under 300 patients had been accepted and scheduled for surgery.

We arrived around 5.30am and the set up began.

The Pharmacy building was the selected screening site, lit up white behind the road. Security made sure cars didn’t stop to drop people off at the start of the line.

Above: Nurses pray before the pre-screening starts.

Pre-screeners wait outside the gate. They will not make a certified diagnosis but have enough medical knowledge to know whether or we may be able to help. It is at these gates that hundreds were turned away.

The line went on down the road into the distance. The early arrival of security meant that the queue was straight and ordered.

Patients area asked to get up as the screening process commences.

Pre-screeners raise their hands to indicate they are ready to see a new person. The potential patients are then escorted to them by Mercy Ships staff.

Above: Maaike Rademaker, the Ward Nurse General Team Leader inspects and admits a woman for screening inside the compound.

Above: A young girl with severe burn scars gets admitted for an operation on her neck to allow greater mobility.

Above: Ben and Sam direct prescreened patients into the compound.

The compound starts to fill up after 7am.

Above: A baby gets weighed before being screened by doctors. Below: Patients get taken round the back of the building to complete the screening.

Above: Michelle shares a smile with the burns girl while she waits to be scheduled for surgery.

Above: This baby is just one month old. She was taken straight to Palliative Care. Unfortunately the family lives too far out to take part in the palliative care program. Harriet, the palliative care nurse gave her some medecine to ease the pain, but medically can do nothing more. Perhaps one day Mercy Ships will expand their palliative care program in the countries they visit.

Above: Safia, the patient at the bottom of the picture with huge benign tumour waits to be screened. The doctors are still waiting to see whether or not they can operate on him. The extent of the tumour needs to further be defined with scans etc.

Above: An unusual patient with two left feet waits in the queue with her mother.

Above: A young cleft lip patient waits with his father.

Above: A mother and baby exchange a look as the nurse takes down the babies details.

Above: Jane White, the screening coordinator examines a boy in the screening tent.

Above: Jeff hands out water to waiting patients who received food as well.

Above: Dr Gary Parker (right) the chief surgeon examines a patient with a small benign tumour.

Above: The last patient of the day waits alone to be scheduled for a surgery.

The almost 300 patients scheduled for surgery was under the target of 500 but another screening will be organised in July or August. The very fact it went without trouble was a huge relief for everyone on the field service. Below: Liz Espeland (Assistant Ward Supervisor) who’s been with the ship for the past three years comforts a baby as the day draws to a close.

Three stories of palliative care

In June I posted about Ayabavi, one of the terminally ill cancer patients that Mercy Ships was looking after. In August myself and Claire visited her along with Harriet and Alex on their last visit. The two weeks previous I also tagged along with the palliative care team visiting two other patients; Lucie and Eklou. The following are very briefs accounts of the effects that the cancer and Mercy Ships has had on their lives, followed by a series of portraits and stills showing where and how they live.

Lucie Amedji

When she first noticed the lump in March earlier this year she felt fine, she was selling second hand clothes on the roadside. It soon got very painful, and she realised her sight was diminishing. As it grew larger her sight went completely. The doctor gave her some eyedrops, but didn’t even mention removing it. She carried on working.

On a visit to Aneho to pick up more of the eyedrops they had another look and told her they couldn’t do anything, sending her to the general hospital in Lomé. They informed her they could do surgery, but the cost was far more than she could afford.

Lucie lives at the Auberge du Lac, a backpackers on the beach of Lake Togo, owned by her Uncle who lives in Germany. He came back to see her and got in touch with Mercy Ships, arranging for her to go to one of their screenings.

She learned about the cancerous nature of the tumour from the doctor on board the ship.

Each week Harriet and Alex bring her painkillers, bandage dressings and fruit. They counsel her, and try to help her cope with her short future. I’ve mentioned before that they often read through the bible with their patients, suggesting areas that may provide comfort. The three patients I’ve photographed in this post are all Christian, and all expressed to me their appreciation for the palliative care team for reading through the bible with them and the prayers they share.

Lucie gets visits from her pastor and members of her church each week. She is grateful for the moral support and friendship they’ve shown. The pain relief the drugs have provided have made an enormous difference in her life. It is this that concerns her most about the Africa Mercy’s Togo field service ending. Without them she is in constant agony, totally immobile and would surely not live long. While she can carry on taking them she has been able to resume her job selling clothes. Without the pain she has been out and about more of recent, and has a certain joy she hasn’t felt in a while.

The supply of drugs that the palliative care team provides will run out a couple of months after their last visit (which was the beginning of August). The cocktail of painkillers she requires costs in the region of $60 a month. Her church community cannot help her financially. She earns an average of about $1 a day.

Lucie.

Lucie and her father.

Looking through Lucie’s front door.

Lucie’s house.

Lucie talks to her cousin.

Lucie and her niece.

Lucie waits for her father.

Electricity cables above the TV.

A bar stool keeps the tap closed.

Fisherman fold their netting after their morning catch outside Lucie’s house.

Eklou Gnakou

He’s had a tumour on the right side of his face for many years now. It’s been operated on twice, both times by Dr. Amaglo, a local surgeon that has worked on the Africa Mercy before.

He owns a plot of land which he used to farm and sell the produce. He carried on working after the first operation, but after the tumour grew back and was removed a second time he was too weak, and had to stop farming.

He heard about Mercy Ships and went to a screening where he was told that he couldn’t be operated on again – it was malignant. He still asked to be operated on even then, but after talking with Harriet he understood, and realised it was futile.

He is extremely grateful to Mercy Ships for a number of obvious reasons, but partly because he would have paid for a third operation which he now knows wouldn’t have got rid of the cancer. He’d like to take the hospital he was operated on to court, partly because they should have told him the operation wasn’t enough, partly because they waited a year before he got the results of the operation.

Money has been an issue for him since he stopped working on his plot of land. He has seven children, four of which live at home. At the moment he is able to feed them all and send them to school, but his eldest son Kofa, 14 works constantly in their garden to make sure food is growing. Kofa tries not to think about his father’s illness. He says that he feels sad when he does, and he doesn’t want to think about who might provide for the family after his Dad has gone. At the moment he can see that his father’s in much less pain than he used to be, and they’re managing at the present.

Though Eklou is more able to work with the drugs that the palliative care team provides, he does not have the money to start up the plot of land he farmed on before. He owns it still, but cannot afford to use it. He needs help from a microfinance organisation, but because of his cancer will almost certainly get turned down.

In an understandable attempt to get rid of the cancer a rich Uncle is paying for him to have radiotherapy in Ghana. Radiotherapy usually shrinks the tumour quite quickly, but if there’s any trace left it will grow back rapidly. There is little chance that the radiotherapy will work, but Eklou is hopeful. – the doctors there have told him that after treatment his cancer will be gone forever.

Eklou talks to the palliative care team.

Eklou’s children leave their toys in the yard.

Eklou explains his concerns for his families welfare after he’s gone.

Alex listens with concern.

Eklou with some of his children.

Kofa and his younger sister.

Harriet’s medical kit.

A blackboard that Eklou’s children use at home.

A stopped clock in Eklou’s bedroom. Despite being Christian, his wife is obsessed with voodoo.

The patch of land in Eklou’s yard that he and his son Kofa maintain.

Ayabavi Fiodegbekou

Before she attended a Mercy Ships screening Ayabavi was pushed around various health clinics, having tests and examinations delayed. Her tumour was very painful, and it was bleeding to the point where she was feinting. Eating was getting harder and the situation was clearly getting desperate. Her daughter heard about Mercy Ships screenings taking place in Aneho; they examined her, taking her to the Africa Mercy to get her tumour scanned. She was told that it was inoperable, but they could provide a palliative care team to help here deal with the pain and help her live the end of her life with dignity.

Before they started visiting she was treated as somewhat of an outcast due to the smell that the tumour was causing. She was weak, barely strong enough to walk 20 metres. She had needed a lot of help just to make it up the gangway on the ship.

The drugs, painkillers and dressings have helped enormously, stopping the smell, and giving her strength and her appetite back. Harriet, Alex and their translator (for the first few months) Sylvie have all become good friends of hers.

Her daughters are grown up and help look after her, changing her dressings when needed, and making sure she’s happy. She spends lots of time with her grandchildren, and will sit down and chat to other people in her village now that the tumour doesn’t smell. She’s taken Harriet’s advice about the best diet to have, but making sure your diet has plenty of vitamins is no comparison to the drugs and painkillers the palliative care team provides. Like Lucie and Eklou, these will run out a few months after the Africa Mercy has left, and she doesn’t know where she will be able to acquire more.

Ayabavi.

Ayabavi’s daughter Tante dries her eyes behind her mother, as the palliative care team talk about life after the Africa Mercy leaves Togo.

Harriet and Ayabavi’s daughters change the dressing on her tumour.

Alex plays with Ayabvai’s granddaughter.

Below three: Stalls at Ayabavi’s daughter’s shop where the palliative care team meet her each week.

Ayabavi prays with Harriet, Alex and Sylvie.

Ayabavi in her house.

Ayabavi’s room.

Ayabavi with a photo I took of her on my previous visit.

Ayabavi leaves the complex of houses where her home is.

The palliative care team in Togo was Harriet Molyneux, Alex Williams, and their translator Sylvie, then Komlan. They provide counselling and advice on how to live the remainder of their life, and are willing to pray and read the bible if the patient wishes. They can provide drugs and painkillers for as long as the ship is in dock and a few months more. The ship’s primary function is to provide surgical care in the areas of Africa where it is needed most. It left Togo to undergo five months of repairs and maintenance in South Africa, extending its service for another 30 years. Mercy Ships can’t help everyone, and leaving an area like Togo where they could clearly carry on working around the clock for many years will always be painful. However Togo is not the only country in need of their services, and once the ship is finished (hopefully in February), it will be going up to Sierra Leone to start a 10 month field service. I’m hoping to join them for a month or two out there.

One can only hope that Lucie, Eklou and Ayabavi leave this world without pain and with dignity.

(L-R): Komlan, Claire, a grandson, Harriet, Ayabavi, a grandson, Sylvie, Alex, Tante and a granddaughter.

Black and white photos of life on the Africa Mercy

This is a rather general blog; I thought I’d share some of the individual photos that don’t usually get made into stories. These were taken at a variety of times, usually when reporting on another story, or while I’m down on the wards taking medical photos. However the first photo is of myself and Claire (Bufe – the writer who pretty much gets all the information that I put in these posts) in our little office.

(Left to right) Missie, Dick and Marina inside the admissions tent (on the dock by the ship).

A toddler wandering around one of the wards where their mother’s bed is.

A cargo ship from Thailand on the dock next to us.

Painting the bow of the Africa Mercy.

A mother sits with her child while day volunteers and nurses sing and dance in ward devotions.

Mary, a ward nurse, takes stitches out of a patient post-operation.

Day volunteers singing during a VVF dress ceremony.

This is Kossi, a 5 day old baby sleeping next to his mother. He was born with a large tongue lesion that almost prevented him from breathing, and became one of Mercy Ships’ quickest admission patients (most are screened many months in advance).

Members of the fire team put on their gear at the start of a fire drill. There are two alarms, a first for the fire team, and a second for everyone else to assemble at the their muster stations on the dock. This ensures that the fire team aren’t blacked from getting to the fire by crowds of staff trying to get off the ship.

Having already been the first group in to fight the (simulated) fire Elliot (centre) and the rest of his fire team changes their oxygen supplies while another team goes in to continue fighting it.

Deck hands help secure a new tyre to the side of the dock. These help cushion the ship when hitting the dock as it sways in the water. New tyres creek very noisily, keeping many of the people in the cabins next to it awake during the following few nights.

Christina, a charge nurse, cheerily looking after an infant (that’s not so cheery).

Day volunteers and staff spontaneously form a band in the corner of Starbucks, keeping everyone entertained after the church meeting on Sunday evening.

(Centre to right) Theo, James and Cael entertain in the corner of the Strabucks cafe in Midship.

In the orthopaedics tent a mother breastfeeds her child while a day volunteer takes off the babies correcting shoes (for club foot) ready for a post-op photograph. Nick, the physical therapist makes notes in the background.

Anama (left), Nick (out of sight) and another day volunteer put the babies correcting shoes back on. They’re not particularly comfortable.

Eye patients sit outside the admissions tent on the dock.

Tracy (Ship Security Officer – centre) and the Gurkhas, who guard the ship: (left to right) Lok, Pradip, Tek, (Tracy,) Ganesh (head of security), Chitra and Min.

A VVF lady listens to a speech during her dress ceremony.

A day volunteer drums during a VVF dress ceremony.

Americans celebrate their independence on the fouth of July with a barbecue on the dock.

Amanda and Anouchka enjoy the dock barbecue on the fourth of July.

Above and below: Crew and members of the Academy throw an American football around on the dock.

Maaike, a charge nurse, tickles Irene, a patient, on a bed in a recently emptied ward.

Josee (centre) plays a card game with Claire and a couple of visitors.

Dr. Leo Cheng explains to Kakou the details of the operation he will perform on him later that day.

Dr. Cheng operating on Kakou later that day.

The port of Lomé from the Bridge.

A member of a vision trip from Texas pulls along a patient on a buggy.

Patients resting in the ward.

Deck workers take a moment to look out over the port of Lomé.

A nurse pushes a patient along on a tricycle.

Medical Portraits

Here are a few more medical portraits. I took hardly any in June because it was mainly VVF patients and for obvious reasons they are not photographed. So I was back on call taking pre and post operation photos this week. These are a mix of post-op photos from the PT (Physical Therapy – these are predominantly fixed bow-legs or club feet) tent and pre-ops of various sorts including maxillofacial tumours and cleft lips. I haven’t included information with them – I think we these sorts of photographs it’s best to see what aspects of their personality you can learn from them – though of course it’s more evident in some than others (you can try and figure out what the person is feeling from their feet if you like). If you would like to know specifics about their condition do email me the link to the photo and I’ll get back to you with details of the condition.

The malignant tumour

Essentially my job with the Mercy Ships is photographer in their PR department. I take the sort of photographs that show what we do to encourage donors. As I’ve said before the donors are key in keeping the charity alive and generally the sort of photographs and stories needed are of the successful surgery that completely transforms someone’s life. I’m not saying we swing towards that in a bias way. That happens with 99% of the patients that come through. I don’t feel that is in any way an exaggeration. But as always with photography I’m attracted to the subjects and stories that stray away from the norm.

The Mercy Ships have a palliative care unit to look after terminally ill patients that surgery would not have worked on. There’s a humanity in these actions that I’m desperate to capture, and I had my first attempt last week.

Ayabavi Fiodegbekou is a tiny grandmother in her 50’s or 60’s. She has had a tumour growing on her face for 18 years, and came out of hiding to attend the screening at the beginning of the the Togo field service. A biopsy and CT scan showed the tumour to be malignant and inoperable. Harriet Molyneux, Alex Williams and their translator Sylvie are part of the Palliative Care Program.  There aren’t as many terminally ill patients on the Togo field service than there were last year in Benin, so the team can afford to venture out further affield to patients houses that they normally wouldn’t because of time constraints. So every Wednesday they visit Ayabavi in her home town of Vogan, an hour or so outside of Lomé and have been doing so for three months  now.

“Our goal with this program is to meet weekly with the patients and be a bright spot in their week. We pray with them, talk to them, and help ease their pain by giving them medication and dietary advice” Harriet says. “She seems to be a lot more peaceful about [her situation] now. We also give her pain relief and talk through any issues she might be having”.

The team takes advantage of as many local resources as she can because at the end of the Togo field service Ayabavi will be on her own without a source for pain medication. The Morenga tree is a natural dietary supplement that is packed with vitamins, protein and carbohydrates. Ayabavi crushes the leaves and drinks the liquid to provide essential nutrients which are lacking in her diet.

When asked how her life has changed as a result of the palliative care program Ayabavi states “Without it I would be already dead. I get excited every Wednesday. It helps make my life better. Before they started coming I was ashamed and those around me would hold their nose because I smelled bad. Now, their treatment has helped make the smell go away.”

Ayabavi’s daughter, Tante (behind her mother above), has seen a visible change in her mother since Palliative Care started coming to see her. Tante says, “I can tell that she feels more comfortable being around others. Before, she never had the confidence to sit among a group of people. Look at her now, sitting with a group of 10 people talking freely. They have truly transformed my mother’s life.”

The interview didn’t go without tears. A mixture of gratefulness to Harriet, Alex and Sylvie and the inevitable situation meant that obvious but necessary questions with obvious answers tugged at everyone’s heart and Sylvie the translator had to stop for a moment after Ayabavi expressed her sadness that Mercy Ships cannot be there until the end.

Mercy Ships is a Christian organisation, and though in no way forces it’s patients to become Christian, or choose not to treat them due to religious grounds (quite rightly of course) it encourages evangelising and telling those it looks after about God and the reasons that so many of its volunteers believe in Christianity. My witness of ‘quick conversions’ to Christianity back home has not always been a positive one in my opinion, but Ayabavi has begun studying the bible as a result of Mercy Ships, read to her once a week by a friend from church.

Ayabavi asked Silvie to read Phillipians 4:6:

“Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God.” The words clearly touched and comforted her, and she smiled for the first time. Noone can deny that in this case the bible has only done good and helped preserve dignity at the end of this woman’s life.

The relief Ayabavi has received has transformed her and helped her cope with her inevitable death. Though the day will come when Harriet won’t be making weekly visits, Ayabavi chooses to focus on the assistance she’s been lucky to have.

“I do not think that any hospital, anybody, any other person could do the help that they can do. They have helped me so much.”

Ayabavi is surrounded by friends, family and grandchildren, the latter of which are often kept entertained by Alex (link included because you can’t see his face – sorry Alex) during the Wednesday visits.

Before leaving, the group pray with and for Ayabavi. Claire and I will return at some point before the end of the field service, meanwhile Harriet, Alex and Silvie will return each week to make sure  Ayabavi is getting the most out of life.

Much of the interview and some of this writing was done by my colleague, Claire Bufe.

The Hospitality Centre

Every now and then I visit the hospitality centre, a Mercy Ships-run compound in Lome about 15 minutes drive from the ship. Here many patients rest and recover after surgery, as well as getting eyes tested and engaging in physiotherapy.

Here are a few shots I took there from a day visit the other week.

The tent where many patients hang out during the day.

Elaine (one of our writers) looks into a dormitory in search of one of the patients she’s writing about.

This is one of our patients, Abel. Here, after a few months of physiotherapy at the Hospitality Centre he can finally walk again. He looked like this before.

Patients have their eyes tested here both before and after surgery. Dozens of eye patients get seen each day and cataract removal and straightening crossed eyes are two of the Mercy Ships most common operations.

This is Sassou, a boy who a tumour behind his eye. I visited his village and school near the Benin border on Monday, and will put up his story in the next couple of days.

This is a Dela Aboudou, who suffered from burns all the way up his arm when he was very young, ‘freezing’ his arm so that he could not bend it.

A Maxillofacial surgery

This is Gafar, a patient who I’m following along with Claire, one of our writers on the Africa Mercy.

He has a large facial tumour and the next series of photos show the scenes I saw in the Operating Room while Mark Shrime performed surgery on him.

This is obviously quite a tough time for a 10 year old like Gafar, you can see from his medical portrait at the top that he has not been happy in a long time due to his tumour and he is about to be put under general anaesthetic for the first time to have it removed. I was not allowed in the room for this as because it is a stressful time, it is best to have as few people as possible surrounding the patient.

Dr. Shrimes marks out where he will cut on the face before injecting local anaesthetic at crucial points.

Gafar is doused in an antiseptic solution before any incisions are made.

OR nurses, anaesthetists and surgeons make the last minute checks before starting surgery.

One of the surgical assistants makes sure excess blood is immediately sucked away – partly to make things easier for the surgeon, partly to see how much blood is being lost.

With an operation like this when a large tumour is being removed there is a lot of excess skin that flaps and can get in the way, so a lot of clamps are needed to pull it back far enough.

An this is the culprit itself on the operating table. With luck and the skill of the team it’s hopefully been totally removed, with no traces left.

The anaesthetist, Kristin attaches a pack of blood ready for a transfusion.

Some phone calls are important enough to warrant interrupting surgery.

having sewn up the flap of skin, staples are added to ensure nothing gets loose.

Gafar’s surgery is finished. At this point I left as I was on call to take medical shots elsewhere so I haven’t yet seen Gafar awake. Hopefully I will tomorrow, and I can photograph a post-op medical shot to complete the archive. I believe Claire will be doing a story about him over the next week or so at some point, so check her blog for it.