A glimpse of ortho

 

Prior to admission, patients and caregivers arrive at the train station parking lot about 1.5 miles away.  A Mercy Ships vehicle brings them into the port, where they wait until they are screened one more time to be deemed fit for surgery.  They are then escorted up to the ward, where they are explained about the process of surgery and soon after take a shower.  The surgical patients take another shower prior to surgery the next morning as well.

All of our ortho surgeries are performed on lower limbs, not arms.  Most of our patients wake up in a cast and the first 2 days after surgery usually stay in bed.  Then rehab starts with the gait training.  Before they are allowed to put pressure through their casts, the bivalved casts must be overwrapped with fiberglass to be strong. 

Once the patients can walk fairly well with crutches, we send them home or to the Hope Center, then they come back in 3-4 weeks for cast change, Xray, and suture/staple removal.  We just started having a few outpatients this week, and boy are we going to be busy!!

I learned how to remove pins, staples, and sutures this week!  Often this involves a screaming child (doesn't always hurt, just really scary often.  But sometimes it does hurt...

As always we have some pretty adorable patients...

Michael --> (with dad on the right) is a chubby 4 year old who had a tibial osteotomy and dad had walking up and down the halls constantly - always ready to give a high five and ask for a balloon.  The only time I saw him frown was when his pins were getting ready to come out...and man did he poke that lower lip out there.  Super cute.

Hardy --> (next 3 pics on the right) is a skinny, timid 7 year old who had a quadricep release with very little quad strength whose knee hyperextended prior to surgery.  Currently he is using a knee immobilizer to walk as we try to get him stronger.  Sometimes he would be sitting on the edge of the bed crying as dad had him practice his exercises of dangling his leg off the edge of the bed to increase knee flexion.  He never complains, but you can always tell by his face when it hurts and it just breaks your heart.  Hardy is now back at home, and I've seen him once in outpatients, and he is very happy.  We left the crutches in the tent as he doesn't need them as long as he's using the immobilizer right now.



<---  Ravette (with mom on the left), had severely hyperextended knees and we were precasting her to try to gain some quad length before surgery.  Please pray for her legs to continue to grow to accomodate into a straight position as she continues to grow.  It is hard to predict exactly what will happen for the kids that keep on growing sometimes.  Ravette is ALWAYS smiling and is a joy. 















A praise report regarding Geril, one of our plastics patients still in the hospital (we still have 3 plastics patients hospitalized to protect areas of open wounds).  Two out of the 3 web spaces that had open wounds when I last mentioned it are now closed up, and the deepest one continues to improve. I will definitely miss him when he starts to outpatients.  I enjoy teasing him in the hallways and getting to work with him occasionally.  Twice I've snagged him to help me do something with the ortho kids, and one of the nurses introduced he and the other plastics guy patient remaining to a bit of hair bleach so they have a lovely rust brown strip in their hair now!  hahaha. 

I would also appreciate your prayers as this weekend Nick leaves, and I am officially official in the rehab team leader roll.  I think my biggest concern right now is figuring out how to have the best interactions with our daycrew...so I covet your prayers on attitudes of myself and the rest of our team of crew and daycrew.  Thank you!!

An overview update (not really that much new...just an overview!)

An update I emailed out, minus pictures unfortunately...

I just wanted to send ya’ll a little update on my time here in Congo so far – I’m sorry it took so long to send something out like this…I try to update my blog a little more frequently, so feel free to check out www.blogspot.wherescwaldron.com as well as befriend me on Facebook.

It’s hard to believe I have been in Congo for over 10 weeks now.  Several days after I arrived we had the big Selection Day in Pointe Noire.  Over 7000 people were in line, with about 4000 prospective patients.  About 1700 were given cards to come back for further screening or admission dates.

It was a very hard day – Nick (my boss) and I felt like we had to turn away more people than accept.  Thankfully most of the diagnoses were evident if it was a condition we could or could not help with surgically for orthopedics.   Our other rehab team members helped out with the plastics screening portion.

The week after the Selection Day, plastic surgeries started.  This is a specialty in which rehab invests heavily – there are many burn contracture patients, birth deformities, neurofibromas and the like which we help the patients regain their movement and strength.  Many of the patients receive skin grafts, so there is a delicate balance of allowing wounds to heal and quickly regaining movement so it will come more easily.  Even though plastic surgery finished several weeks ago, we still have a handful of plastics patients in the hospital who needed a 2^nd graft or whose wounds are taking a very long time to heal.  Erin, our hand therapist, makes plastic splints for the patients who need them to optimize functional positions and regaining range of motion.  I was able to do a few small finger splints myself this year, so I was excited to put a new skill into practice – even if they were only for the pinky finger!  J

Orthopedic surgeries started 2 weeks ago and will continue for another month.  In orthopedics, we only operate on children – this usually assists in healing time, (As well as they are easier to carry up and down the many flights of stairs if needed!  I just realized how thankful I am for that fact this week after carrying up a little girl whom we are precasting before her surgery next week!  There are 42 steps from the dock to the ship, and 64 steps from the gangway down to the hospital just in case you were wondering!)  Probably the most common procedures we do in orthopedics are femoral or tibial osteotomies.  This is performed on a child with knock knees or bow legs to make the legs straight and involves cutting the bone, adjusting the position, putting a pin or screw to hold it in place, and then casting the broken legs.  The cast is then cut in half to accommodate swelling for several days, at which point one of the rehab team overwraps the cast again with fiberglass to allow the patient to stand on their newly straightened legs for the first time (usually about day 3-5 post operatively).  Usually the older kids do well and the smaller kids scream.  We have one particular fellow named Gaga, however, who at the age of 4 is quite the little soldier and always with a very serious look on his face accomplishes whatever he sets out to do, which lets 6 year old Grace beside him see things are not so scary.  It’s funny how the dynamics of ward medicine influence a patient’s reaction to treatment!  So the past week I have been learning much more about casting – overwrapping, wedging casts to overcorrect alignment to accommodate for future growth, windowing casts for pin care.  Since I was not here during the inpatient phase of orthopedics in Guinea, these are new things to me!

I am also starting to take over the duties of the rehab team leader as Nick leaves in just 2 weeks.  I think I’m a *little* past my horribly overwhelmed stage, but I don’t know if that will return once he actually leaves or not!  Managing a multinational team of changing people in a changing patient population is definitely going to be a challenge!  Thankfully most of the crew has been here before, so I will only have 1 person totally new to the ship to train.  We have been able to get a little bit of extra help of about 17 hours a week from other crew members with physical therapy backgrounds, so that has been very helpful to our team of 4 fulltime crew and 3 dayworkers.  There are many days when the crew work late, shorten lunches and don’t get as much done as they wanted to, so we are still trying to prove by our statistics that we could definitely use more help.

Biking & camping trip to the beach about 40 km away

On a different note, exploring some of Congo has been fun.  I am now a ship’s driver, which means I can check out a Landrover for $0.35/kilometer for up to 4 hours.  Driving in Pointe Noire is its own adventure – constantly looking out for pedestrians or vehicles not doing what you expect them to, with few traffic lights to navigate busy intersections.  In comparison to what the driving looked like in Guinea, however, there is much more orderly driving here, for which I’m thankful.  It’s easy to get to some decent beaches (though I haven’t yet gotten in the water due to strong rip tides), and I’ve also gotten to go upcountry to Dolisie twice – once for pleasure and once for hospital business.  In Dolisie the mountains are all around and you breathe a sigh of thankfulness at the beautiful scenery and slower pace with friendly people.

Life on the ship is busy, though it perplexes me how it can be so busy seeing as I have no commute time, and don’t have to grocery shop or cook my own food.  That should make up for at least an extra hour per day!  There is something usually each night that I participate in, whether it’s Bible study, Tuesday night pizza, inservices, meetings or ultimate Frisbee.  This past week our rehab team went to the house of Bob, one of our dayworkers.  His sister prepared a wonderful meal of 2 kinds of fish, chicken, fried plantains, rice, and a bean/cassava leaf mixture.  We met more of his family and had a good time of laughter, stories and fun.  He recently moved to this house which is very far away on the outskirts of Pointe Noire, but has 3 bedrooms, a common room and a kitchen.  It houses him and his 2 boys, his brother and sister in law with their 2 children, and his sister who will be returning to her home in Brazzaville soon.  Elly, his sister, worked all day to prepare the meal for us, so we felt very honored. 

So just wanted to give you a little picture of what life has been like so far – God is definitely teaching me a few things through this change in position that I am not able to do everything on my own, sometimes my typical approach to a problem may not always be the best, and overextending oneself does have some consequences.  I invite you to pray with me on these things:

·         Healing for our patients (especially our plastics patients that are still hospitalized – particularly Geril, one of my favorites and a sweet teenage boy with deep wounds between his fingers)

·         Being a support to my friends and accepting their help when I’m overwhelmed

·         Adequate staffing for rehab – particularly late Nov/early Dec when staff changes and someone is on vacation and in Jan – March when the 2^nd block of plastics runs yet outpatient ortho is in full tilt

·         Health and safety – I’ve had a little bit of a runny nose the last few days

·         Actively pursuing God and not being passive in my relationship with Him

·         Figuring out how to be the best team leader I can for rehab – protecting and caring for my team, managing cross cultural differences, providing an atmosphere of spiritual growth

The beginning of ortho!

So this week I started working with the ortho patients mainly instead of the plastics patients.  And boy, what a entry in Monday was...  We overwrapped 2 patients' casts, overwrapped and placed our experimental pelvic bands on 2 more patients, wedged 2 other patients casts, windowed casts for pin care, the whole 9 yards...basically, any crazy casting things that need to be done was done, giving me a good taste of what the next 6-8 weeks hold!  (And there is no way I could have accomplished all of that myself - Nick instructed me, dayworkers and nurses also helped...funny how it can take up to 4 people to get a small kid's cast exactly how it needs to be.)

Ortho is pretty awesome because you see a very obvious result with the surgery - curved bones are straightened.  It definitely can be hard work...I could use a rolling stool to help the little kids walk as they're a little shorter than is good for bending over to help with their gait as they learn to use a tiny little walker or crutches for the first time.  Often you have to move their legs for them, sometimes they're very painful, and currently we've had a couple patients go ballistic with itchiness (of course we tell the nurse who gives them some benadryl or the like and it calms down).  I might go ballistic with itchiness, too, if I keep on getting fiberglass stuck on my skin...I currently look like I have a massive scrape on my forearm...but it's just because I was using red fiberglass to overwrap a cast today!

One of the sad parts about starting with ortho is having to say goodbye to my plastics patients...  Most of my plastics patients are in outpatient now, but I had about 5-6 still inpatients as well.  I would love to ask for ya'll to pray for Geril.  He's one of my favorites...teenage boy with a super sweet nature, he tries really hard and doesn't complain, but he's been in the hospital a long long time with areas in between his fingers that are taking a very long time to heal.  He will continue having therapy, it just won't be me because I'll be switched over to ortho.  But with the healing, his movement is limited because you can actually see the finger movement pulling at the wounds when his dressings are down...such a hard balance sometime to figure out wound healing vs. preserving/regaining movement.  But he needs your prayers to protect him from infection as his wounds are still quite deep, and protect his heart as well - I can only imagine seeing many of his friends discharge to the Hope Center or home would get very frustrating after a while...  Yet in the ward church service you see him smiling and singing along, and he always is ready to tease me or give me a smile.

Geril is in the yellow shirt with 2 other of my patients (Eliezar and Wame), a baby sister of another patient, and a nurse.  Eliezar is featured in the awesome video I will post when it becomes available...which apparently now isn't until December 3rd.  Sadly you will have to wait!  (But it's such a good video...and I'm even in it!  :) )

Thank you for your continued prayers and encouragement!!  I am definitely missing the fall (Mama put up some amazing leaf pictures!), but have been indulging in some pumpkin and apple goodness.  I'm organizing a 4 on 4 beach volleyball tournament for this Saturday...sadly my 3 on 3 dream team will not make an appearance.  Thursday our rehab team is heading to one of our dayworker's houses to have dinner with him and his family so that should be fun!

Nick is leaving in less than 3 weeks...it will be so weird to be here without him as he's the only boss I've had here and who tends to know the answers to everything I need to know.  And all those strange Australian quirks I've picked up without meaning to.  Like today actually calling a walker a "hopper" ( then afterwards I had to explain to my dayworker today that only Australians call them such things), saying "Whoa!" too often or "no dramas" or "are you happy to do ______".  Talking smack and having a good foozball partner.  I think only his girlfriend will be more sad to see him go...

So with that God is stretching me definitely in how I take on work and prioritize things...so please pray for me to learn these lessons quickly!!! :)

Dolisie and Biking to the Beach: 3 off ship trips

A pic of the rehab team at our open house a few weeks ago...

So it's been quite a while since I've blogged, as tends to happen, I get caught up in life in Africa and the thought of sitting behind a keyboard waiting for a blog to upload is hard!  But I am lying on a bed in a hotel about 3 hours north of Pointe Noire watching Kenyan TV (the only one in English) and resting before dinner. 



Driving back from Dolisie in "rush hour" market traffic

 There are 4 of us up here checking out one of the 4 general hospitals located in Congo.  The health system here is set up in tiers of types of hospitals - at the top is the University hospital in Brazzaville, below which are 4 general hospitals which have a fairly decent number of surgeons usually and can give somewhat more specialized care.  Beneath that are many other health clinics and smaller hospitals.  Private hospitals also exist - including some of which are mission based.  Two of the 4 general hospitals are in Pointe Noire, 1 is in Dolisie, and 1 is in Wondo (sp?) further upcountry.

So the reason for me being here is because on screening day we saw 1 patient had a very good brace, and they had said it was from Dolisie.  So since Mercy Ships will not be in Congo forever, and our patients sometimes need braces or orthoses of sorts for a longer time than the lifespan of the brace or 2 that we would give them, we are on the lookout for in country options.  Unfortunately once we had the tour and asked about the brace making in person instead of just over the phone, it turns out it is actually done in Brazzaville and not Dolisie, so I was a little bummed about the decreased options for our patients.  Thankfully there is 1 place in Pointe Noire that fabricates some AFO's (ankle foot orthosis) and the like, however, while quite resourceful in using the plastic from yellow water/gas jugs, it's not quite as sturdy or as moldable as some of the other plastic options out there. 



The big tree in Dolisie



The hospital tour of Dolisie hospital is quite impressive however...The director is quite proud of his very, very clean hospital which they clean 2x/day!  They also have >100 toilets, and >200 beds.  The hospital is blessed with continuously running electricity and water, which is sometimes quite hard to come by, and most of their equipment works, which again, is pretty impressive.  Even the mission hospital in Kenya that I was in was not this clean.  It did seem to be lacking generally in patients, however, for the size.  There were a few people in the wards, some in the ER/observation rooms and some having consults with the general medicine doctors.  However specialists come very rarely in from Brazzaville, so not often are all the facilities used.  They only have general surgeons regularly, however if they really need to transport someone to Brazzaville for an acute orthopedic surgery or the like, they can cast them to hold a position, then fly them to Brazzaville (which is about 12 hour drive from Pointe Noire, so I'm guessing about 9-10 hours from here?).



Simbissi waiting to be cooked at Dolisie hospital



sunset at Food for Life

 

We got to go meet up with Eliphaz, the head of the agricultural program while here and see where the Food for Life site is - it is still under clean up/construction and will start in a couple weeks.  They work with NGO’s and government groups to promote and teach good practice with crops (composting, crop rotation, organic pesticides), animal raising (chickens, rabbits, goats), things you can do with products besides just the straight produce (like yogurt, cassava flour). 

Now I am finishing writing this a few days later…

I got to go out with Eliphaz and our 2 daycrew that were with us to a restaurant later that evening.  I tried N’goki – which is a small crocodile that lives upcountry in the muddier rivers and such – pretty tasty – kind of like a cross between pork and chicken.  Earlier in the day I had eaten Simbissi…which wasn’t as tasty, and best I can figure out is kind of like a ground hog.  Apparently they serve that in the hospital, too, because we saw 2 in the kitchen.  J



Now a couple weeks ago I got to go to Dolisie for the first time with Steven, Myriam, and James.  We went up on a Friday night via taxi, got to explore Sat and Sun.  It is always so nice to get away from the hectic-ness of city life (ya’ll know I’m a country girl…), and to be able to see mountains always makes me happy.  Congo has much better visibility than Guinea, allowing you to actually see the mountains more easily.  The road to Dolisie is pretty awesome – twisty, curvy but very few potholes, though plenty of speed bumps to slow you down near any town, and on the trip to Dolisie this past week I got to drive part of it myself!  (not quite as much fun in a Land Rover as a car…) 

But anyways, on the first trip to Dolisie, we got to check out the market, I bought a little bit of fabric, camped and had a great campfire meal, jumped in a pond “Lac Blu”, and hiked around a bit, meeting some of the locals from about a 200 person village near where we camped.  One interesting meeting involved winding our way down a little trail and coming across a family pulling manioc out of the water.  Manioc/cassava is the staple starch around here – it’s a root that the family collected from a nearby forest, then soak for 5 days to get the bitterness out of it.  I think at that point you can cook it to eat it, but you can also pound it and get the juice out and make foufou out of the manioc flour.  Foufou kinda looks like a grey-ish drop biscuit.  I personally like foufou better than cassava because it doesn’t have quite as strong of a flavor.  But anyways, this family was quite happy to explain their process to us, found out about what we were doing there, and we gave them a couple apples we still had, so everyone came away happy.  J  We also met the head of the village, who happens to be the brother/brother-in-law of the family that was retrieving cassava.  They offered us some fresh peanuts.

So that's a little of my upcountry adventures.  Last weekend Krystal, Juan, Missy and I biked about 40 km up to a nicer area of beach and spent some time relaxing, strung our hammocks up in a little shack, and spent the night.  I was definitely the slow poke of the biking group, at one point a man with a very nice bike came up behind me.  We had a half conversation in French, and at one point he tried to push me faster on my bike.  Now that was kind of embarrassing...  :P  He has something to do with the Total petrol stations around here...but he said he doesn't work, so I didn't quite figure out if he's an heir to a lot of money (judging by the look of his bike), or what.  It was an interesting scenario.  But it was really nice to get away once again.  Funny how sometimes this ship feels so big (when you have to repeatedly go from floor to floor), and yet other times seem so small that you have to go far away to clear your mind and rest a bit. 



Dinner





We had delicious fresh-caught-that-morning fish for dinner, I got a multitude of sand flea bites and sliced my big toe open (thankfully it has healed up without any signs of infection despite the inability to keep it clean for about 18 hours following the injury), burned a ton of random wood, ate campfire pancakes and eggs, and collected sea shells and something else that my mom will receive in the mail so I can't write it here...  :) 

Marshall Islands: Kwajalein

So now having a few weeks under my belt at Kwaj, I can give a little update as to what things are like here!

We'll start with work.  So there is a small hospital here with maybe 4-6 beds, lab, ER, minor procedure rooms.  I have a separate physical therapy office a few blocks down, but I come to the hospital for a couple of meetings, getting scripts, etc a few times a week.  My little clinic has a gym, treatment room, and an office, plus bathroom and kitchen/laundry, so I am very nicely set up.  I have been doing my notes on paper due to the fact that it would probably take about 5-6 weeks for me to get a Computer Access Card (CAC), and by then I would be gone.  That being said, documentation is a breeze!  :)  I have mainly orthopedic patients, everything from total knee replacements, to sports injuries, to chronic low back pain.  Since ortho is my love when it comes to PT, I'm pretty happy.  :)  I have an hour/patient and can schedule however I need to to accomodate schedules.  So it's a pretty sweet set up!

My room ins in a BQ (Bachelor's Quarters) kind of like a hotel room and I eat in a dining hall.

As far as the scenery here on Kwaj, it's pretty amazing.  We have the Pacific Ocean roaring in on one side and a more protected, calmer lagoon on the other side.  There is plenty of coral, beautiful fish, lots of nurse and reef sharks (I did see a few small reef sharks on my last snorkel, but the bigger nurse sharks hang out by the boat dock and get fat with people throwing them fish guts after they go fishing...around here people act like they're big puppy dogs...).  The water is clear turquoise or dark blue depending on which side you're viewing.  Coconut palms abound (as well as the sign to watch your head for falling coconuts).  Coarse white sand lines the beach, but I think it is dredged a time or 2 a year.  If you're into watersports, this is amazing.  I've been snorkeling 5x in 4 different spots - 1 time before church, 1 time before work, and once actually when I didn't have to go somewhere afterwards.  I got to try wakeboarding once, which is TOUGH!  My forearms felt like I'd been doing a lot of rock climbing for about 4 days afterwards.  I only got up for a decent round once, making it through a straightaway and about half of a curve.  (Wakeboarding is like snowboarding while being pulled by a boat.)

So the social life here reminds me a lot of being aboard the Africa Mercy.  I see a lot of the same people at the dining hall at breakfast, lunch, and dinner, and you make new friends constantly.  It is also a very transitional island with people constantly moving in and moving out.  (Probably not as much in the fall-spring as the summer, however.)  You walk or bike everywhere...unless you're a paramedic, security, garbage man, or have access to a golf cart.  Thankfully Nikki, the PT for whom I'm covering, let me borrow her bike while she's gone.  For 1.1 square miles, it actually can feel like a long distance to get some places sometimes.  I think you can make a loop up to 7 miles long, or just "doing the runway" is about a 5 mile loop.  I've gotten to play some beach volleyball, done some swimming (they just drain and replace the pool with ocean water 1x/week), had some Zumba classes, ran, and worked out at the gym for exercise.    There is definitely a party feel - I think this is kind of like the Key West of the Pacific, except without all the good food.


Everyone is very nice and welcoming, and being a female there is no lack of compliments or chances to hang out with the opposite sex as the male to female ratio is quite high...at some point I might get a big head and start to think I'm a supermodel or something...  ehhh, probably not.

There's also a great deal of history here, even prior to WWII, but I was blessed with the opportunity to get a tour with one of the island's archeologists on Roi-Lamur, a 30 minute (free) plane ride away from Kwaj where about 80-100 people work and live.  This is the island where the huge radar systems are to track missiles.  It has been explained to me that between the 3 radars on Roi they could count the droplets leaking out of the space station easily (if droplets were leaking...not that they were...)  It definitely zapped our golf cart a time or two and killed it...  Thankfully it restarted.  But there are many left over Japanese buildings, lots of graves (that have and have not been completely discovered), some post take over (you can tell my military terms are pretty scarce) American buildings.  Very interesting and neat to imagine how the battles took place as you're standing on the spot.

I am so thankful for the chance to have been the PT on Kwaj for a short while, the work and play combined fora great fit for me!

Post Screening Day thoughts

So Screening Day was definitely a success...there were about 7300 people in line (including caregivers), and over 4200 patients were seen/screened by different surgical teams.  I don't know how many patients we screened in ortho - rough guess would be anywhere between 300-400 possible patients.  (We had about 125 +/- "yes" patients and it felt like we had atleast twice as many "no" patients.)  It was the biggest screening day in Mercy Ships history.
 THE LINE

It was a tough day for Nick and I...Nick is my boss, an Australian physio.  Thankfully he's done some screening before as without our orthopedic surgeon actually being there it did fall to us to make the decisions of who was/wasn't a good candidate for orthopedic surgeries.  We did have several cut and dried criteria - only operating on children (who will heal up faster plus be easier if we need to carry them up/down the stairs while they might be in casts or nonweightbearing.  Also we were just doing lower limb surgeries, so no upper limb stuff (although some of those we were able to refer to the plastic surgeon instead)  For those needing a tendon release, criteriea were limited as well.

The reason it was a tough day was because we felt like we said no to so many people - many many possible patients that came through the line had cerebral palsy, and be it someone with low tone and decreased ability to sit/walk by themselves, or having more tone where they had very tight muscles that may benefit from a tendon release - most of those we had to say no to unless it was 1 sided and they had good strength and it would really improve their function.

So it felt like some stretches we had to say no to everyone...sometimes you would just be able to look at a person and know they were not a candidate, but you still wanted to treat them with the love and compassion that they need.  Yet at the same time you knew there was a massive line continually waiting for you to see them so you didn't have much time to spend.  But even if they couldn't have surgery I still wanted to give some idea of possible treatments that might help them, give a stretching tip, etc.  It was hard to find the balance of quickly yet compassionately caring for people and trying to answer questions they had - often it was like they were at a doctor's visit and would ask what else could they do and expectations they could have, but I felt very limited by time and even knowledge - not knowing what is available here in Congo as well as not being familiar with all the range of diagnoses that came through.  But I love it when people are proactive about their health, so I wanted to try to answer as much as possible...so tough.  Thankfully it was fairly cut and dried which patients we thought were good candidates for surgery, so atleast we didn't have to waver back and forth on decisions.

At the end of the day we had to put all of the heavy wooden desks back in the different classrooms we used, lifting them over banisters and cramming what seemed like way too many desks into a room, so that was a hard end to a long day.

So overall I really don't know how I feel about Screening/Selection Day.  I was very excited for it - I even had the butterflies in the stomach like before a big sporting event.  But the day itself is very difficult emotionally, because you know so much more could be done, so much more is the inequality between the western world and much of Africa and other developing areas.

I've been reading the Beatitudes recently, and it makes me think of these patients we had to say no to.
Blessed are the poor in spirit (discouraged), for theirs is the kingdom of  heaven.
Blessed are those who mourn, for they will be comforted.

Also, right above the Beatitudes it talks about Jesus healing the sick (Matthew 4:23-25), of Jesus healing EVERY TYPE of disease and sickness among the people.    And he healed them all.   So maybe Screening Day is also a good reminder that while we might have a lot of skillful medical practictioners, a lot of fancy equipment, and have the desire to help all the patients possible in West Africa, we are NOT Jesus.  We still need him despite our thoughts that we can handle some things on our own...
  My Mercy Ships family and home sweet ship...