Yesterday is not Tomorrow

“Kay, are you alright?” I hear a knuckle tap my door. “Can I come in?”

I bury my tear-stained cheeks in my pillows and whimper. There is nothing easy about being twenty years old.

“Honey, what’s wrong?”

I consider the best way to answer my mother’s question: my body is livid that I went another month without getting pregnant? ISIS has taken over my uterus? Or should I stick with what my gym teacher taught my 6th grade sex education class? “Girls, your period will surprise you, but I can help. When it comes, stop by my office and tell me that your ‘friend’ is visiting from out of town. That’s our secret code.” WHAT? Thankfully I’m an adult now, which means that I can tell the truth. I unbury my face and glance at my mom with sad, smeared eyes.

“I have my period.”

“Aw, I’m sorry. Did you take any medicine?”

“No–I can’t.”

“What do you mean?”

“I’m not taking medicine for periods anymore.”

She raises her eyebrows. “Why not?”

“So I’m prepared to give birth.”

The door clicks softly; I can hear my mother chuckling as she walks away. Isn’t she proud of me for my valor? Why doesn’t she commend me for good planning? She returns with a glass of water and 600 mg of ibuprofen.

“Sweetheart…” She strokes my head in a someday-you’ll-understand kind of way. “Nothing–absolutely nothing–can prepare you for the pain of childbirth. Take the medicine.”

I did.

Years have passed since my short-lived medication embargo. Now I bolus tylenol and ibuprofen when my ‘friend’ visits from out of town (within safe limits, obviously). In hindsight, I can see that my rationale for avoiding medication was more than just preparing for childbirth; I wanted to toughen up. I didn’t want to be weak, and I associated medications (especially prescriptions) with being weak.

There aren’t many prescription medications that I’ve taken in my life. But there is a certain class of medications that were most difficult for me to take: mental health medications.

Over the past few months, as I’ve shared my own story (the one to follow, not the one regarding periods), I realized that I am not alone in my sentiments. Countless friends have whispered to me their own anecdotes of anxiety that are seasoned with loneliness, purposelessness, weakness, and fear that there is no help or hope to come.

Three hundred and sixty-six days have passed since I had my own mental breakdown. I am finally ready to share my story. I hope that my experiences resonate with you so that you know you’re not alone.

-March 28, 2017-

Despite eating every meal, I had gradually lost weight for months. A dark stress shadowed my every move. I wasn’t sleeping; I had transformed into a dark-eyed zombie. I couldn’t invest in people so I withdrew from groups. Mentally, I wasn’t often present anyway. Social interactions made me nervous. I starting eating meals alone in my room. The workload never ended. Cynicism tucked me into my bed each night. I had no energy to invest in loved ones. I felt like a failure.

I remember vividly crying that Tuesday afternoon in the crew physician’s office on the Africa Mercy. I couldn’t believe what the doctor had told me. All your labs are normal. I think you have anxiety. What?! I had thought I had cancer. Or hyperthyroidism. Or both. NOT anxiety. This scared me more. Anxiety seemed like something I couldn’t control–  instead, it was something that controlled me. She prescribed medication for me and told me I needed two things: sleep and time away from the ship.

Six days (and hundreds of tears) later I arrived in a 70-degree Cape Town at the home of a dear friend and mentor. One week with Trudi Venter was enough to fill my emotional gas tank from 0% to around 50%– just enough to sustain me for the remaining 10 weeks on the ship. I survived my last two months on the ship but those days were still taxing. I certainly wasn’t fully recovered after only a week’s vacation in South Africa.

After I returned to Michigan my primary care physician bettered my prescription and referred me to a counselor. Before I left his office that day, he told me one of the most empowering truths:

“Kayla, you don’t need this medication. But I think it will make your life easier for the next few months as you transition back.  It will make your relationships, your work, and your personal life go more smoothly. I really don’t think you will be on it forever.”

My doctor’s soft words communicated a crucial message to me: you are exactly as you should be. You have endured more than most. You have done an excellent job. Now you need support–relationally, professionally, spiritually, medically. Use your supports to get back on your feet.

I knew that I had reached my limit in every way. Quick-fixes I had tried for months (serving, exploring, working, investing, distracting myself) no longer eased me. So I decided to take my doctor’s advice.

With a prescription bottle in hand I walked into autumn slowly and firmly. I attended counseling sessions. I spent time with loved ones. I said “no” to opportunities I knew I couldn’t handle. I knew I wasn’t living the most glamorous season of my life (I mean come on, I moved back in with my parents and worked part-time at a clinic). Eventually, though, my kinks worked themselves out. Now I am feeling stable and grounded.

I recall one evening last spring when I was out for dinner with AFM physicians Lindsay and Dianne Sherriff, and my co-workers, Ria and Rachel. The Sherriffs asked us to verbalize a goal for the upcoming year. This was an easy question for me to answer. The only thing I craved was to feel like myself again. To return to normal. Almost a year later I am certain that I will never return to my old self. But that’s a good thing.

Life ebbs like foamy ocean waves, vacillating between high tides and low tides, but it’s always shifting. We are only stuck if we refuse to move our feet. Do not fear walking into tomorrow, for it could be different from yesterday. Accept the break from work or the prescription or the counseling or the kindness, grace, love, support, etc. If you don’t want to be on medications longterm, then act while you’re taking them so that you can get off of them.

The illusion that you are not allowed to be weak is neither helpful nor sustainable. Be honest and vulnerable, and ask for help.

Or Prozac.

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The Moment I’ve Avoided

I haven’t logged into this website since May. In fact, I haven’t even looked at my blog since May. This delay is not accidental; I have pondered blog topics nearly every day, yet I’ve avoided writing at all costs.

You would think that a tumultuous and uncertain season, like my past five months, would render more blogs, more funny stories filled with hiccups and doubt.

But, no.

Here’s why I haven’t written: I like to have things…. okay, everything… figured out before I share it with the world. With you.

I think I can blame pride for this one. My pride instructs, only share your insecurities once they’re behind you or once you’re ahead of the problem. I believed pride. And I waited and wanted desperately to write but I feared what the outcome would be if I didn’t have my issues sorted through. I was waiting for my sudoku-life to have all the numbers filled in perfectly one-to-nine. But my timeline wasn’t exactly realistic.

Finally, I gave up. Now I am attempting a different approach. Instead of waiting, I’m writing before I have everything figured out.

I will admit that I can’t take full credit for realizing that perfection does not exist as a minimum standard. Fortunately, I can thank my therapist, Todd, for that. Todd is the best. If I ever were to forget that he’s worth the money (which I don’t), I only have to glance at the clock at the end of a forty-five minute session to remember that he’s worth every penny. Our vulnerable conversations pass as naturally as a slight breeze, only tangible for a second but the refreshment lingers for days.

The world needs more Todds. And the citizens of our world need better access to the Todds out there. Alas, to avoid picking favorites, cheers to the many empathetic and hard-working counselors out there. We love you.

Speaking of love, I am going to love you better by being vulnerable. Here’s the messy update on my life: some days I feel rejuvenated and encouraged, sort of how you feel when you’ve worked a long stretch of early mornings and then you don’t have to set your alarm clock for the next day. I feel accomplished and satisfied. But most days I feel more like a math equation that cannot be solved easily. I plug in a few numbers thinking the new value will yield the correct result. Nope. Try again. Cross multiply? Factor the quadratic equation? Does that even make sense? You say, yes, it makes sense. Okay, we’re getting close. Nope. Wrong answer.

Against my will, I carry my wrong answers with me wherever I go. My favorite spot to dump them (besides Todd’s office) is at church. A few weeks ago my pastor asked the congregation to stand to read a prayer together aloud. I like when he asks us to stand together. There’s something supernatural about disciplining myself to do something that isn’t a comfortable proclivity. Actually, I’ll sit this one out. Oh, that’s right, I sat through the earlier part of the service. Yup. I can stand. Sometimes I find freedom empowering, but there are moments that I feel discipline even more empowering, like my soul has control over my impulses. This is why I love mornings. I would prefer to laze in bed but when I toss my jelly-legs onto the carpet (and feel slightly light-headed because I shot up like a bullet) to greet a dewy sunrise, my soul wins out. If I had listened to that misleading inclination, I would have missed the day’s first beauty.

Back to church. I’m standing.

Disturb us, Lord, when we are too well pleased with ourselves,
When our dreams have come true
Because we have dreamed too little,
When we arrived safely
Because we sailed too close to the shore.

Disturb us, Lord, when
With the abundance of things we possess
We have lost our thirst
For the waters of life;
Having fallen in love with life,
We have ceased to dream of eternity
And in our efforts to build a new earth,
We have allowed our vision
Of the new Heaven to dim.

Disturb us, Lord, to dare more boldly,
To venture on wider seas
Where storms will show Your mastery;
Where losing sight of land,
We shall find the stars.
We ask You to push back
The horizons of our hopes;
And to push into the future
In strength, courage, hope, and love.

Credit attributed to Sir Francis Drake

The prayer’s words resonate with my soul. It seems odd to me to ask for disturbance, especially during a year when I feel discouragement every day, as if it were my middle name. But there is something freeing about this prayer. Perhaps disturbance isn’t so ill-received when we ask for it. In the process of asking, we’re letting go of our personal outcome.

This is what I learn and re-learn and practice only to forget and to try again: care about injustice passionately, but do not tug-of-war for control of things that do not belong to me. Maintain healthy boundaries. Do my best. Ask for help.

Hopefully, you can learn from my lessons even though they are not yet fully learned.

Love,

Kayla

A special thank-you to the beloved friends who supported me over the past year, specifically, my last few months on the M/V Africa Mercy. You know who you are, but other people don’t. Ria, Rachel, Nate, Andrea, David, Dianne, Kelsey, Michele, Scott, and *insert your name*. You are dear to me.

Hitchhiking to Nowhere 

The border patrol officer skimmed my passport. “Where are you staying in Togo?”

Pause. “I don’t actually know,” I said, my eyes avoiding his gaze. If only I had known then just how true the statement would be. I rested my chin on my sweaty fist.

“You don’t know?” His eyes were now directly in front of mine. “What is the phone number?”

I shrugged. “Uh…we don’t know that either. Kat, did Anna tell you the name of the AirBnB?”

Across the room my friend was having an almost identical conversation with another officer. I caught her eye. We didn’t need to exchange words in order to reach the same conclusion: if we wanted to make it through customs efficiently, we had to banter our way to the other side.

Kat turned back to the officer, ready to charm with her signature Cuban lip pout.

“We’ll figure it out, right?” I shouted, my hands extending out as if I were on Broadway. “Pas de problème!” The officer dodged my outstretched arm and stamped my passport.

“Bonne chance!” He said with a chuckle.

“Claro que si!” The Spanish words came ringing back from Kat’s table.

“You speak Spanish?” The officer asked her in broken English. “Como estás?”

Kat winked at the officer as he handed her the passport. Knowing that we were departing celebrities, we slowly backed off stage left to exit Benin and enter Togo.

Giving each other a high five, we planned our next move: catch a taxi from there to Lome, the capital, and from Lome travel 2 hours north to Kpalime, where our friend Anna awaited us at an AirBnB…or so we thought.

Before we could say “Bonjour” a policeman secured us a taxi. We felt spoiled when we realized that the taxi had AC. Off we zoomed, feeling like queens.

Aggressive bartering in Lome landed us our final taxi to Kpalime. Squeezed into the back of a four door sedan were four women. We made short introductions then turned to face forward. Our hips crunched as we took off, then drifted into numbness until the occasional jolt revived sensation. In the west the sun was setting; the northern sky threatened rain. Relishing the fresh air, we maintained rolled-down windows as if our courage would postpone the downpour.

Two hours later, still confined to the rear of the taxi (which was now starting to feel like a prison) I received a text message from an unknown number:

This is Anna. In Lome. Call me. I am at hotel Lily, on the beach road. Come there with moto.  

I squinted, confused. “Anna’s in Lome?”

A fuzzy phone call revealed a hiccup in our plan. Kat and I had left a day early, thinking that a longer weekend could only be a good thing. But Anna had not received our messages about coming to Kpalime a day early. She wasn’t even there.

“You guys are insane,” she said, “The reservation was for tomorrow night—not tonight—but it doesn’t matter. I called the AirBnB lady. They’re painting the house. We can’t stay there at all.”

“What?!” I thrust my jaw in irritation. “Under what circumstances is it okay to cancel last minute so you can paint your house?”

“I’m running out of credit,” Anna said, the signal crackling, “I will come to Kpalime tomorrow. Try to find the YWAM house. Maybe you can stay there. But it’s not in Kpalime…it’s in some village on the outskirts of town.”

The dark drive continued as we propelled north into the unknown. I called the YWAM house several times. Finally, a male voice answered. “There is no room tonight. You can come tomorrow.”

“Can we sleep on the floor?” I pleaded.

The man laughed. He thought I was joking. I wasn’t.

Kat and I assessed our options. It took a grand total of five seconds for us to realize we didn’t have many. We could try to find accommodations in Kpalime but we didn’t know the town and we would arrive late.

“I have my hammock,” I said, “We could sleep in the bush. It’s a two-person size. I call little spoon.”

At that moment a Togolese man in the front of the taxi turned around to face us. He must have disliked our wilderness idea because he asked how he could help. I explained the situation to him.

“Hey,” I asked him, “Can you ask this woman if we can stay with her, just for tonight?” I motioned to the woman we had greeted earlier. Before the man had even finished translating to her, she shook her head and turned her back to us.

“Do not worry,” he said, “I will take care of you. My name is Seth.”

I was really hoping he would say his name was Jesus…but Seth was alright. We decided to entrust ourselves to our acquaintance in the front seat.

About thirty minutes later Seth signaled the driver to stop the car. I glanced out the window. We were nowhere near civilization. There. I spotted two lights about 100 meters off the road. He motioned us in that direction.

We walked in silence for a few minutes until we entered a concrete compound. Two pairs of eyes peered at us curiously behind the safety of their mother’s skirt. We walked through an open area and into a dimly lit living room. There we waited as instructed for dinner. “This is my native village,” Seth explained. “We will eat here then I will take you across the road. My uncle has a guesthouse. I think you can stay there.”

We ate fou fou, which is yam pounded into a moist, thick paste. Add some fish stew and voila, we had our evening meal. We drank bag water until we could expand no more.

Seth, who had excused himself during the meal, reappeared in the dark room. “Come,” he said, “we can go to the guest house.” Kat and I wrestled our bags onto our shoulders and followed Seth outside. We crossed the road and traced a dirt path. Left turn. Walk. Left turn. Stumble. Readjust head lamp. Walk. Turn. I glanced at Kat with wide eyes and retraced our steps in my mind.

We arrived inside the guest house and were escorted to a small room with a double bed and a bathroom. Before he left, Seth grabbed both of our hands and prayed with authority for our safety and protection. “I will see you in the morning,” he said, passing us the room keys. He closed the door behind him.

Kat and I stared at each other.

“Do you know where we are?” I asked her.

“HELL no,” she replied, laughing. “There isn’t a single person in the WORLD who knows where we are right now.”

I thought for a moment. “You know…I kind of like it.”

A few hours later gentle light coaxed our sleepy eyes to reality. Dawn. My favorite time of the day, especially when breakfast is within reach. The staff took our coffee order.

“Shoot,” I said a few minutes later, sipping the sugary paste. “We forgot the ‘no sugar’ addendum.” We opted to venture caffeine-less rather than drink a lifetime’s worth of dental cavities. Nevertheless, we departed with grateful hearts. Jesus Seth bid us farewell after he prayed again for our safety.  He had already paid for our accommodations but we offered money anyway.

We hitchhiked along country roads and aimless goats until we found our coveted destination: the YWAM base. After room arrangements had been settled, Kat and I dozed in my hammock for a few hours.


Squawk! My eyes opened. A flock of birds darted into the sky as if a predator had pounced. I peered above the seam of the hammock for potential danger. Aha. A voice resounded. This roaring laugh and a bizarre accent could only mean one thing.

“Anna!!” I yelled.

Finally, albeit a day late, our trio had come together.

The reunion was sweet. Anna is the kind of girl who would sign an apartment lease in a foreign country without looking at a single photo. She is unpredictable and lovely. Anna chided us for being idiots and then complimented us for being brave. We slurped mango skins and tossed around the idea of squeezing three into the hammock.

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World, meet Anna Psiaki.

Some people might call us senseless, others might say we’re wild. I’m not really sure, nor does it matter. All I know is that I was refreshed after spending time with women who drummed to a similar beat. The following two days in Togo delivered some of my favorite moments of my life.

Together, we refused a guide and hiked into the Togolese wilderness, determined to track down an elusive waterfall. Not surprisingly, it took us way too long to find the waterfall, and then we spent far too long at the waterfall. We donned our damp shoes as dark blue swells clouded the evening sky.

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We speed-hiked to mountain’s base with only a few minor cuts and bruises. Far from the nearest town and without transportation home, we corralled around the last moto driver. He agreed to let all three of us squeeze onto the back of his bike. Our quartet sped off, clamoring for grip and fist-pumping every time our motorcycle didn’t bottom out.

Lightning reached its talons into tumultuous clouds above us. In Kpalime we dismounted our noble steed, thanking the driver for a safe return. Only one more stretch remained until we could satisfy our groaning bellies. Within a few minutes we had bartered our way into a taxi. At the time we didn’t realize our chauffeur wanted to kill us, but we found out soon enough.

Shovels of rain dumped onto the poor excuse of a taxi, drowning our windows in blurry streams. Every few minutes the driver packed more people into the car, barely pausing for passengers to settle before he lurched like a bat out of hell. For most of the trip we held our breath…until Anna couldn’t hold it anymore.

Jutting her chin forward, Anna yelled at our taxi driver in French, “Monsieur. SLOW DOWN. WE DO NOT WANT TO DIE TONIGHT!” He paused momentarily (not from driving 60 mph, but from slapping the inside of his windshield with an old t-shirt) to howl with devious laughter and swerve to miss an innocent goat. We opted to depart the taxi well before our destination.

See, we have some sense!

Needless to say, after a warm pasta dinner we tucked ourselves in early. The rainy season flexed and roared all night.

The following morning we enjoyed an Easter breakfast before we bid the YWAM base farewell. Loose coins jangled in our pockets as our trio skipped along the dirt road. We pulled out the camera and shared genuine smiles, thankful for another shot at life.

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World, meet Kat Sotolongo.

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Long hours of travel provided an opportunity to reflect on the weekend. We agreed that Togo is lovely but we don’t like taxi drivers, and we’re allowing ourselves to generalize. We risked safety for the sake of a good story and took some amazing photos (correction: Kat took amazing photos.).

Time away from the ship gifted us the space to stretch and disclose and discuss everything that crosses a twenty-something’s mind. We planned poorly and pretended that we had no regrets.

It’s also important to mention that we prayed—a lot. And we came out alive and better than ever before.

Cheers!

Kayla

​Did you know that beer is really cheap in Togo? But if you order it roadside and want to take the bottle with you you have to pay “extra.” Question…is it considered extra when the price of the bottle is worth more than the beer itself?

Try not to be intimidated by my harmonica skills.

Photos taken by Kat Sotolongo @katsoto ​​

Moons & Menstruation 

“She has five children.”

“What?” I had completely zoned out. “Five children?” I glanced at the health record in my hands. “But when I screened her in Kandi she told me she has eight children. Eight pregnancies, eight deliveries, and eight living children. That was only three months ago.”

Esther, my fellow team member and translator, raised her eyebrows and looked at me like a dense student. “I know, but I am telling you what she says now. She has five children.” 

“Did the other three die?”

“No,” Esther shook her head with finality. “She had seven pregnancies, two died, and now she has five children that remain.”

Deep breath. I straightened my back, engaging my dormant muscles. From what I could tell my arse had sunk through the limp cushion on my stool. Pretty sure we’re touching metal now. Nevermind the pressure ulcer forming. Focus.

“Okay, let’s keep going. Can you ask her which year she had the pregnancies and how they resulted? You know, vaginal or cesarean or abortion or miscarriage?”

Esther got to work while I changed the patient’s recorded pregnancies. As a western nurse, obtaining the obstetric history of a woman from northern Benin is exhausting because the cultural clash is so tangible. Sure, my college education taught me about cultural differences, but did those classroom lessons warn me that sometimes I would want to bang my head against the wall? No.

After about ten minutes Esther handed me her sheet of paper. “Finished.”

I skimmed the information. “This is good,” I said slowly, my eyes absorbing the numbers. Long screening days and broken air conditioning make for slow mental processing. “The numbers add up!” I gave Esther and the patient a high five.

“This might not go over well but…when was her last menstruation?” I asked tentatively.

Esther spoke with the patient then turned back to me. “She is not sure. Before the last moon.”

Well, at least we tried.

I nearly responded, “that doesn’t make sense,” an expression so frequently used over the four weeks of Women’s Health screening that it acted as my sidekick, or at the very least a desperate plea for the information to obediently oblige to my nursing framework. The better response would be, “that doesn’t make sense to me.” My patient’s system of moons and stars does make sense….to her.

I can confidently say that Women’s Health screening this spring exposed me to more than I could have imagined. I shamelessly cried as women relived their nightmarish histories, gripped patients’ hands during painful examinations, repeated myself hundreds of times, and handed out more pads than a middle school gym teacher.

Needless to say, I am exhausted and definitely don’t have the desire to birth children anytime soon (meaning 0% to all the statisticians reading this).

But the tough weeks were worth the effort, acting like growing pains that ultimately yielded something good. Women who once leaked urine are now healed, the dryness restoring dignity. Some women we couldn’t help, but I hope that they received emotional healing from the safe space we created during the screenings. Even if we cannot heal, we listen. Sometimes that makes all the difference.

International Women’s Day was a special day that we listened and danced in order to celebrate our patients. The beauty of women’s day, particularly this past one, is that women from thousands of miles away gathered together in mutual song and dance. We adorned ourselves with bold fabric and bright lippy and flailed our shoulders and hips to a shared beat. We could so easily have been each other. I could have been the spirited woman from the bush. She could have been the gangly short-haired nurse. I didn’t care about our communication difficulties. We celebrated because we are equally and abundantly fabulous.

From now on when I remember the difficult weeks of Women’s Health screening the most prominent memories will be the celebrations, both for IWD and healing through surgery. Those lively hours serve as a purposeful reminder of how similar we actually are. It is okay that we use different systems and forget how many pregnancies we’ve had. It is perfectly acceptable to mourn the loss of a child decades after the death. It is wise to value children and to advocate for our bodies.

At the end of the day the aspects that don’t matter are the brief frustrations and fleeting impatience, scratched out medical charts and sore muscles. What matters is that we are all walking a journey, at times together and sometimes separately, but together we are walking.

And, more importantly, we’re going somewhere.

 

 

Photo by Timmy Baskerville

1,000 Words

Some people say a picture is worth a thousand words. My friend Suzanne happens to be pretty skilled at taking photos so I reckon hers are worth even more.

I’d love to share some of the photos she has taken of Benin. Some of are Cotonou, where our ship is docked, and others are from surrounding areas.

I hope you enjoy them as much as I do. Blog post coming soon, I promise.

 

 

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The sunrise view from the bow of the M/V Africa Mercy, facing east. Cotonou, Benin.

 

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The entrance to the port.
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Deck 7 starboard side. It took me over a year to learn the difference between “bow” and “stern” and “port side” and “starboard side.” Well, okay. I knew the words but they didn’t seem to stop me from getting turned around.

 

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It wouldn’t truly be a sunrise without a cup of coffee, would it?
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Palm trees paint the path along the Atlantic shore.

 

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A fruit and vegetable stand, one of the most satisfying sights.
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Wide open roads invite clarity of mind. Benin has pretty good roads extending throughout the country. But you must always, always watch out for the goats!
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A breath of fresh air– and sand.
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I think you dropped one?

 

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Fresh fruit and happiness brought to you by roadside stands since….well, forever?

 

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The zemi (moto) is my favorite way to navigate Cotonou. We pay about 30 cents per ride and yes, I always wear a helmet. *pats self on back*
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People meander the alleys in Cotonou.

 

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Afternoon rest.

 

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Why wear pants when you can run better without them?

 

Love and peace from Benin.

Kayla

Unrecoverable

I glance at my watch. Eleven o’clock. I rub my eyes, aware that my hands are far from clean. Dried sweat and grimy hand sanitizer cling shamelessly to my knuckles and nails. But I couldn’t care less.

Twenty feet in front of me over two hundred people wait patiently, both anxious and eager to be seen by a nurse. Some arrived last night, determined to make the appointment on time so they slept on the hospital compound. Others come today for their screening appointments with Mercy Ships. Either way, today is the first day that these potential patients will meet a crew member. Expectations are high.

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Dusk falls as patients wait outside the hospital compound the night before the screening. Dassa, Benin.

Last September twelve referral day crew (local translators hired by Mercy Ships) traveled north from Cotonou to register people who live in the bush, far from blood pressure cuffs and scalpels. The day crew sent us (screening nurses) patient information via phone and instructed the people to come today.

Early this morning we reminded our patients that these appointments are not for surgery but only for screening. The surgeons are not here today, and they need to see the patients themselves before a final decision is made. Still, people come expecting surgery today because hope is unyielding.

Our hopes are also high; however, some of the patients we preregistered are not good candidates for surgery. My team approved appointments based on demographics, minimal medical information, and photos. As my dad would say, “For every one thing you miss for not knowing, you miss ten for not looking.” He’s right. A face-to-face visit with a patient reveals far more information than what is transmitted over a phone (singles, remember that for dating. It applies there, too).

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Upcountry screening.

Infrequent glances at the crowd inform me that we have a long day ahead of us. I watch the jagged line shift as patients inch their way towards me. December does not equal cold weather in Dassa, Benin. It’s quite warm despite the overcast morning. We are nestled within the hospital compound. When I say “nestled” I actually mean crammed along a covered path attached to the hospital building.

Mel, Rachel, and I set up our screening stations in close proximity to Ria, the surgeon screening coordinator. As the patients queue to the nurses, crew members measure their temperatures and take their weights. Rachel, Mel and I assess potential patients. If they are good surgical candidates we forward them to Ria, who schedules an appointment for the patients to come to the ship for diagnostics or a surgeon screening.

Upcountry screening.
Rachel measures the diameter of a facial tumor.

Eleven o’clock. I shift in my chair and focus again on the patient in front of me. Samuel, my translator, tells me that she takes no medications from the pharmacy or market. No herbs or leaves or roots. “Okay,” I respond, “You can wait at the end of the building to see Ria, a nurse who will give you an appointment for consultation at the ship.” I smile at the patient. Her smile consumes her face; her eyes disappear.

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I motion the next patient to come. I can’t help but notice the messy clothing sagging from his limbs. The fabric seems to be too heavy for his frail body. He approaches me calmly.

Samuel, my translator, tells me the patient has come for a hernia. There isn’t time for formalities so we get right down to business.

“Okay, can you ask him to show me in a private room?”

The patient agrees. The three of us step inside a dimly lit room. Many curious eyes from the waiting line follow us. Privately, I assess his hernia and scribble a few notes:

  • 14 cm
  • left-sided, inguinal
  • + reducible, + painful, + scrotal involvement
  • No previous surgeries

We return to our seats. Something seems off. The patient is wearing a winter hat over his head. That’s pretty full on, I think to myself. We’re in West Africa. Winter hats are not necessary. The man catches me staring at him. He points to the back of his head and quickly removes his hat.

My eyes widen. At the nape of his neck lies a softball-sized tumor, weeping and open-sored. I exhale, my breath saturated with disappointment. This mass is slowly murdering him. I can’t form words. Instead, I continue my exam.

His eyelids are more pale than my yovo (“white person”) skin. He reports ongoing nausea and fatigue since the tumor started growing less than a year ago. He is unable to work as much as he used to because he feels ill. I skim the screening sheet. He is only twenty-nine.

I know what to do, but my heart stutters. I need a team member’s agreement, so I ask Mel to come. She confirms my assessment. “There’s a high probability of malignancy,” she says sadly.

I look at Samuel. He is doing an amazing job.

“Samuel,” I say slowly, “I want to tell you this first before you translate. This patient cannot have surgery on his hernia. If he has surgery he may not recover because he is so sick. Can you please explain to him, however you think is appropriate, that yes the hernia is there, I can see that. But it is not causing him to be sick. The real problem is the tumor behind his neck, and Mercy Ships cannot help with this kind of tumor. He needs to go to the local hospital to see what kind of treatment they offer. I am so sorry that we cannot help him.”

Samuel nods. He pauses, contemplating, then begins to speak in the man’s local language. I feel frustrated that I cannot communicate directly with my patients. I would love to know what they actually think about the situation. But, simultaneously, I love working with translators like Samuel. I trust him to deliver the news in a culturally appropriate manner.  He is sensitive and respectful to the patients.

The man listens quietly, expressionless. After, I invite him to ask questions. He inquires once more about the hernia surgery.

I swallow. “It is not possible for Mercy Ships,” I answer. The man looks at the ground. Then, rather suddenly, he thanks us, gets up from his chair and walks to the exit of the compound.

I motion the next patient over, and we begin again.

The day is taxing for the team. We turn away many patients who are too sick to have surgery, but who also have little hope for treatment. Children with ascites, aggressive spinal tumors, and rare genetic disorders that surgery will not improve. Adults with hypertension, diabetes, anemia, and oozing wounds. These problems are only a small representation of the conditions we see.

At some point during the day each of us takes a moment. “I need a minute” is a common phrase we use. My teammates are strong but also very human. We feel the patients’ emotions and reactions. Processing and debriefing with each other is a crucial aspect of screening.

Come to think of it, I think that’s what this year is for me: constant processing. Every day I witness the plights of the poor. I talk with those who have been abandoned, neglected, and forsaken. I discuss ethical problems and am forced to make decisions that usually don’t feel good. Over time, that weighs on a person.

Nate, my supervisor, has worked in screening for several years. He once told me that this job has changed his perspective on life. “For better or worse, I don’t know,” he said. “But I know that I don’t ever want to recover.”

I don’t want to recover either. Right now I wouldn’t trade this job, one teeming with raw human suffering, for anything.  I will always remember these delicate stories. They hold me accountable to live responsibly, walk humbly, and pray constantly.

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Screening day preparation includes sorting through patient lists, transcribing information, and organizing transportation lists. Natitingou, Benin.
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Screening + Security teams in Dassa. Stunners.
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Sunrise in Parakou.

Playing God

“We have been waiting here since Monday. We came from Nigeria.”

Our eyes meet. I glance at the four-year-old twins next to him, both struggling to balance on extremely bowed legs. I try to hide my expression from their father, fearing my transparency will only make the situation worse.

“Please. You can help us?” His words feel like fire.

I apologize again. The response doesn’t feel natural at all, but thick and poisonous. My explanation regarding a full orthopedic program cannot dissipate his tangible sadness. Or his continued questions.

“But they have pain. Can you fix it?”

My mind knows the answer is still “no” but my heart cannot support it. I need back up.

“Nate?” I beckon my supervisor. “These twins…they’ve been waiting outside the gate for five days. I know we can’t…but I need your confirmation.”

Nate’s gaze falls on the young girls. “Technically, we can’t,” he says softly.

I turn back to three pairs of desperate eyes. Feigning confidence, I repeat that the program is full.

The father is staring at me. Finally, with a quick nod he motions his family off the cement slab and toward the exit gate. I watch the man shuffle through shifty sand, trying to support his twin daughters. My heart breaks. I feel like a liar.

Our orthopedic program isn’t full.

As a screening team we had decided to allocate the sixty one orthopedic surgery slots. We divided the slots among three weeks, which is how long the screening center is open. The alternative was to take all sixty one patients as they come. First come, first serve. If we had chosen this option our slots would have filled in about three days’ time.

Some team members thought it would be fair to offer surgical opportunities to patients who will journey to Cotonou over the next two weeks. We agreed that we would attempt this approach. This meant that we would take only ten more orthopedic patients this week. We had already found those ten.

 I had thought we made a sound decision. After all, I had turned countless patients away this week. This is difficult; however, “no” is more straightforward and undemanding when the patient doesn’t meet surgical critera. I feel okay when I can shunt the control elsewhere because the disappointment is not my fault. You’re too young to have the surgery. Mercy Ships only offers this to women who are past child-bearing age. Or I’m sorry, but Mercy Ships does not do this kind of surgery. Or unfortunately, surgery could make the problem worse. These conversations are certainly sad, but they’re doable.

This “no” felt completely different. Gone were the external factors. I had no organizational chart to fall back on, no exclusion critera to support my verdict. These Nigerian twins met the requirements for surgery, but there is an overwhelming demand so we had to pick and choose. Our selection system seemed ungrounded and unstable. I don’t even want to make life-changing decisions for myself. How can I make them for other people?

When the decision is mine (or ours, as a team) the responsibility feels sovereign. The power is dreadful and condemning.

I feel like I am playing God.

Speaking of God, I am not sure what Jesus would do in this situation. He faced desperate eyes and crippling ailments. I am willing to bet that he felt overwhelmed. Even though his divine nature had no healing limitations or surgical quotas, I am convinced that as a man he felt aching disappointment and deep discouragement in every breath he took.

I watch the twins approach the exit gate. I want to scream, Come back next week! We have more slots! But what if they are too late? What if they can’t make it through the gate? What if they are the ninth and tenth orthopedic patients in line, and are denied again because we accept the first seven?

I turn back to the weaving line of people, some of them soon-to-be patients. The queue seems more like a maze of fraught individuals eager to come out at the right end. I signal the next man to approach me.

Now I understand what Jesus would do. He would keep meeting with those who are suffering. He would come back to this cement slab every day. He would remain open and continue to offer his heart to the wounded, broken, and downtrodden.

Just because you can’t help everyone does not mean that you don’t try to help anyone.

 

0700 at the screening center. outside the gate nearly a thousand people gather every day .

Disclaimer: This is a personal and private page about my experience aboard. This is not an official Mercy Ships page. The reviews and statements presented here may not reflect the beliefs of the organization.