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

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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.