farewell

Today is our last day and it is with mixed emotions that I write this. Tomorrow morning I (we) will be disembarking from the ship, The time has passed so quickly I am not sure I have truly been able to appreciate what I have had the opportunity to be a part of. I have been honored to work along side amazing practitioners who have been committed to teaching me even when it was over 100 degrees outside, 10 hours into a 16 hour day, with lines of children and families still waiting to be seen. I won’t go so far as to say I have gotten my feet wet with regards to practicing independently, maybe just my toes, but the experience will stay with me for a lifetime.

I have seen so many truly needy families, adolescents who work instead of attend school, or for some, in addition to attending school. Families torn apart by illness, I saw one family- a grandmother and three young children whose mother had passed away just 8 days prior to their visit with me. Unfortunately all of their ailments seemed to be related with the pain of heartache and mourning, I told the grandmother that there wasn’t a pill a could provide or a treatment I could suggest that was going to ease their pain, they just needed time to heal. She began to cry and I could see the strength drain from her face, she was alone with the children. As she wept she was holding her 3 year old grandson on her lap, when he saw grandma cry his little bottom lip began to quiver and he began to cry, I wanted to sit and cry with them because it was breaking my heart to see them. I think she just needed to cry and someone to listen, I sat with her for a while and just allowed her to talk, that was the best, and only, medicine I could provide.

I went out for 7 days in a row and all the days have blurred into one. Luz and I had the chance to go out to one of the local hospitals to help teach/translate NRP updates and a lecture of therapeutic hypothermia and perinatal asphyxia. The lectures were intended for the physicians and med students but due to an emergency patient that needed to be tended to only the nurses were available, we gave the group the option to hear the lecture or not as it may be beyond their scope, they requested that the lecture be presented anyway because they felt that they provide care at times that is intended to be done by a physician. The lecture was presented and the nurses were great, made me proud to be a nurse... they asked insightful questions and seemed to be soaking up all the information to the fullest. There is some horrible statistic in this country regarding the number of babies that die each year, I can not remember the exact number but they seemed to grasp the enormity of it and were interested in learning simple life saving measures, if just one baby is saved we/they have made a difference.

There is a program put out by the AAP (i think) called Helping Babies Breathe, it was created in response to the fact that in many countries if a baby does not take a first breath spontaneously they are set aside and pronounced dead. The class teaches proper drying and stimulation of the baby, how to use an ambu-bag properly and deliver good breaths and proper suctioning of the nose and mouth. We were taught the basics on teaching the course, it seems like such basic care but to many babies and families it is life or death.

The most difficult part of this mission, for me, has been the limitations on what I can really do. The children who so desperately needed care were the ones who could not be helped directly at our med sites. I saw a child with CP whose mom was told that the cause of the child’s malformation of her feet was due to a seizure she had 6 months ago, we spent some time discussing CP and the associated physical and possible cognitive sequelae. I treated an 11 year old boy who had one leg longer than the other which caused him to limp and have pain, I referred him back into the community to see ortho and for possible corrective shoes, maybe surgical repair. But what I have heard is the most likely solution is a trip to a local carpenter and have him construct a shoe lift.

One case that really surprised me was a 5 year old girl, cute as can be, and the complaint listed by triage had to do with her ear, I could not really make out exactly what the issue was. Once the child sat down with me I immediately realized that she had a malformed ear, with just the lobe on the right side and she was missing her thumb on her right had, mom was concerned that as she grew she would have problems with the internal structures of her ear and wanted to be sure she would be ok. What surprised me was that mom not once mentioned anything about cosmetic concerns, she told me about how the girl had learned to write with an adapted way of holding the pencil when I spoke to her about the possibility of having a ear molded and surgically attached she looked at me like I had three heads, the service is available on the sister ship the Mercy (I have been told).


This has been a lesson in learning that I can’t fix everyone, sometimes education is all I have to offer, sometimes just listening is all I can do and all a person needs. This has been a humbling experience, a lesson in humanity and humility. All we need to survive are the basics, the rest is fluff. Parental love and concern are the same in every country. Children are resilient, families adapt and communities come together when the need arises.

I am sad to go but of course looking forward to going home, I will always carry with me the experiences I have had here, the knowledge I have gained. At the end of each day the exhaustion would take over but I had to remind myself that this was just a moment in time for me relatively speaking, soon enough I will be home with A/C, access to medical care, a cabinet full of snacks, essentially all the “luxuries” of home. At the end of the day for me I found that laughter was the best medicine, I enjoyed sitting around with our group sharing the good and bad of the day and if I was lucky I went to bed with a belly ache from laughing.

Many people said this trip would change my life and it has. I have made lifelong friends. I have learned more about medicine that I thought possible in such a short period of time, I have relearned the art of a thorough physical assessment and exam. I have learned a little more about myself and my strengths. I will try to appreciate all that I am blessed to have. When I think that things are bad I will remember the children who had the strength and courage to keep smiling in spite of it all and the mothers that keep it together. I will draw strength from them and remember things could be worse. I will eat all the food on my plate because there truly are starving children somewhere, in far away lands and in our own backyard.