Thursday - Surgery Day #4 - Can't believe it's the LAST DAY!!!

 It was another rainy & stormy night, but I slept 9 hours which is exactly what I needed after getting 5-6 hours of sleep a night since I have been here. I was so happy to find out when I woke up that I had RUNNING WATER , so I could have a proper shower – or at least a “Ghana shower”.  I was a little slow getting ready, and still had no internet. Timing wise Doug was up late in Utah so I was able to talk to him this morning. I rolled into breakfast right at 7. The dining room was completely full and no one was eating as the food was not there due to the staff having difficulty getting to work as a result of the storm & once they got there, they had to prepare the food.

For the morning “meeting “Team Leader Updates” Della said he wanted me to speak for PACU which was very nice of him. Afterwards I was told by others that was an act of him “respecting me as a colleague, and demonstrating we are partners. This is especially meaningful in areas where women are not always respected. He is a CLASS ACT! In my PACU status “update” I mentioned what a difficult day it was in PACU yesterday with patients coming out “wild” & crying & also that we lost & had to restart 5 IV’s. I asked that since this was the last day that they please secure the IV’s & bring us more calm patients. If the child is already not doing well at the end of the case please give more anesthesia. We all had our team shirts on & took photos both at the hotel & at the hospital. The Africans LOVE their photos and if a photo is being taken of 3 people & 8 are nearby they will all rush over and join in to be in the photo and they also love to flash the peace sign in their photos. Their enthusiasm is contagious. I was in the front seat next to the driver going to the hospital & perhaps I had not noticed in the back of the bus but he drove like a maniac… passing the Pragias & barely slowing down when people were crossing the road…it would be bad press of OSI to cause an accident in a town they are supposed to be helping!!!  

At the hospital Abi & I went to pre/post first to see yesterday’s patients -truly my favorite part of the day. After that I needed to meet Salam & she took me to the bank (with the same ATM I had been using) as the one by the hospital was out of money – probably because of my daily withdrawals! She and I shared a sweet conversation reflecting on what we have accomplished in the last 8 days since we met in person in Ho and how this food will truly bless so many individuals and families. On Tuesday when I was in a panic to get cash the Clinical Coordinator in Training Cynthia is a member of the church and said she asked me If I belonged to the Church of Jesus Christ of Latter Day Saints - & she assures me I said NO. Mind you it was a stressful day & I could have answered NO to any of a number of things I SWEAR I did not hear that question. Fast forward to Wed morning and she asked me again & I said yes & explained what Salam & I were doing & introduced them. I chatted with her more throughout the day – her parents & family joined the church in 1995 as some of the first member in Accra. She moved to the Cape coast after she got married and has 3 children 15, 13,11. Her husband like Salam, is also not a member of the church but is very supportive. She is the oldest of 6 siblings all raised in the church in Ghana. Today she asked me if I lived in Utah & told me her youngest brother just graduated from BYU. He went there on a track scholarship & he also just got engaged. She was such a proud sister & showed me the photos. I got his contact & told her we live in Calif but have a house in Utah and I will contact him when we are there for 4^th of July.  She said she hoped I would come back to a mission on the Ivory Coast – the next one is in September I think & I said that may be too soon but I would love to come back to Ghana.

I returned before any patients did which was great and we had a slower start to PACU which allowed me to begin and complete the PACU Team Leader/Educator evaluations on all 6 of the PACU RN’s. I also met with each one of them briefly to share what I wrote so there are no surprises & I scored them all well as they were truly a great team 😊 Some of them also called me “Miss Nancy” all week-it was cute. One of the female Anesthesiologists Elizabeth also called me “Miss Nancy of the PACU” – earlier int eh week her kids often came out fussy & agitated & I mentioned it to Clover as the Anesthesia lead & she really worked with her on her medication dosing’s & timings & the last 2 days her patients became a dream entering the PACU. After my little speech today she walked in with every patient & said “Miss Nancy I am bringing you a patient just how you like them”. She was a delight to work with  

One of my most embarrassing moments of the day was when a news crew came in & asked to interview me about PACU & the reporter was holding our a “silver disc” I thought it was a pin or something she was giving me (which some visitors had done) so I reached to take it & it was her microphone for the interview. I sure hope they do some good editing on that segment! After that I ate lunch & I had my peanut butter sandwich. The lunch at the hospital was the same everyday so after 2 days I started telling Patience just order whatever anyone might want to take home – I was quite happy with peanut butter again today and switched it up with protein bars 😊

Our first patient came at 11 am then within an hour we had 4 patients & all of our beds full. They were all out by 1 pm & the next batch came in; at 3 pm the last round of patients were on tables. We thought they would be in PACU about 5 & the dinner was at 7. However, the last patient arrived at 6 & was a 22 year old lip repair who had been teased his entire life & he was a BIG BOY & had some bleeding. We watched him for an hour & sent him to the ward at 7:15 & didn’t get back to the hotel until 7:45. They had delayed the dinner but the entertainment – very loud African music & dancing was going strong & I could hear it from my room 4 buildings away. I easily could have skipped the party, but I felt like I needed to at least make an appearance, so I went at 8:30 & Clover & I made a pact to leave by 10 pm. I sat with Abi & her niece & her little boy Nana; he is so cute & just a month older than Demi. The dancers tried to get people to join them & Cherish went up – which was impressive & she was working on her moves & matching their moves!!! They also had the standard slide show & “speeches” gave certu=ificat4s out & Clover & I left a little after 10 & I was in bed by 10:30.I will get packed up in the morning. Can’t believe the mission is over….

Late Entry for Wednesday Surgery Day #3 -It was a DOOZY & 1st Load of Humanitarian Food received

 Again, there is no internet so I am writing this Thursday Morning for Wednesday in word & hoping I can publish it in my blog at some time.  Woke up Wed. after a short night to no rain & a sunny day that felt less humid but there are still LOTs of mosquitoes even inside the PACU so I am glad I am on Malarone the anti-malarial medication. At breakfast they announced that we will be condensing all the patients to 4 days finishing surgeries tomorrow & not have any surgeries on Friday. I was actually SO, SO GRATEFUL I thought to ask for my flight to be changed from Saturday late night to Saturday morning, . I am used to later nights & was concerned about finishing a half day of surgeries on Friday, packing up the PACU, packing up myself and then the drive to Accra. So now we will have the “Final Dinner” Thursday night I will get to sleep in Friday without a 6 am alarm &leave at noon to drive to Accra, stay at the same hotel I was at before & get the hotel transportation to the airport. That plan will be much less stressful 😊

Abi & I went straight to post op this morning in our street clothes to see all the sweet patients from yesterday – the last older patient Dennis & his sweet grandma, Phillip & Daududa who was sleeping. After that we went back to the ATM to withdraw my max cash amount before we connected with Salam to go and purchase food at the warehouse. So much for it not being humid because after I walked the 150 yards to the ATM & back I was a sweaty mess!  Classic reason why I don’t wear make up on missions.

Humanitarian Progress: Abi wanted to go with Salam & I to the warehouse so I let Princess & Eddy know we would be gone for 1 hour & hope to be back before too may patients got to PACU but Beatrice was “in charge” they seemed ok with that. We connected w/ Salam at 8:45 and drove about 40 minutes to the warehouse…do not think Costco or Sams club…we are talking a warehouse with dirt floors & food on wood palates this is where restaurants & stores buy supplies. They sold perhaps 10 types of rice in varying quality (bugs?), oil, canned sardines, large cans off tomato paste, sugar & things I didn’t recognize. I assume there are “food staples” in Ghana. We picked a quality of rice that Abi gets (I trusted her) then selected the oil & sugar & did the calculations of the quantity of each depending on how they were packaged. Each family would get 25kg of rice that was easy or so I thought until they came back & told us ALL of that brand of rice was already sold???? to the “store” we had been to on Sunday, and of course the store raises the price a lot. Instead we bought the same brand of rice but in bulk (not the  5 kg individual bags inside the big bag) & decided we would add a plastic storage bin for them to put the rice in that could also be bought at the market. Rice -DONE. Then we requested 13 of the 3 packs of oil…they only had 11 so we had to upgrade 1 of the 3 packs to a higher grade oil. The tomato paste came in too large of cans so those will be purchased elsewhere. The large bags of sugar they were going to divide for families were not available so we got the individual bags packaged in bulk which will be easier to those leaders who will be putting together the individual “baskets of food” for each family ( that itself is going to be so much work & they plan to do in the next week or so). Getting “checked out” with the “big boss of the warehouse” seemed like a process & I was concerned we had been gone too long so I pulled the we need to get back to the hospital card-showed a before 7 after phot of a patient & they seemed to move faster. I paid in cash, got a receipt, while Salam was coordinating delivery at the actual church building with the driver who said her would call her when he was on the way so she could meet him there w/ a couple of men who would help unload.  LOGISTICS!!!! They had added a few other families so it will be 40 total with food for 2 months & we are adding protein as well. We removed 2 elderly who need more “ready prepared food” (no clue what that means in Ghana??? We were back to the PACU by 9:45 just as the first patient was coming in from the OR – perfect timing-I didn’t miss a thing. Then at 11 Salam got the call the food was being delivered so she left the hospital & went to the church – she took a few photos & a video….I do want to see it – 2200 pounds or rice is A LOT – that made my heart so happy & I sent the phot to friends who either gave me money before I left or have so graciously sent money while I was here. Later in the afternoon when I had a 15 min break in the chaos (see below) Salam & I met to review what we had spent, what we needed in cash& what we had in cash with the ability to withdraw another $1200 tomorrow. That was all the humanitarian time I had today which was good because the PACU was CRAZY!!!

Mission: It was a very crazy, chaotic loud day the entire day between 90% of the patients coming out of anesthesia confused, combative & crying, the inability to fully “silence” alarms on our equipment, a few patients with complications, IVs coming out and the actual nursing needs it was a DOOZY!!! At one point my Apple Watch alerted me that I was in a LOUD ENVIRONMENT – I already was living that!

At 10:30 a simple lip repair came back with some oozing internal to the lip. Surgeons said the patient had no bleeding on the table & they we also in their next case. The nurse & I watched it for about an hour before I told Della – he wanted to put more pressure on it & watch it for 10 min. After 10 min he got the circulating surgeon to come check which is when all the crazy happened. The sweet little guy almost had to go back to surgery mostly because the surgeon didn’t have good visibility to where ethe bleeding was coming from. We sedated him in the PACU, applied gauze with adrenaline to hopefully vasoconstrict wherever the bleeding originated. We gave TXA a drug that helps with clotting about 12:30 & then we “on watch” for 2 hours.  During all of this the decibel level in the PACU had to be high. IVs coming out, patients screaming & needing medications to relax – there was definitely something in the air impacting nearly every patient even 1 or 2 from Table #1. We occasionally settled but it was an “off vibe” all day.

So SURPRISE when the 1^st bus left people did want to escape the crazy & I sent 4 of them back to the hotel and 3 of us stayed – I stayed since I am on call anyway. The last patient came to us at 6 pm and was an adult lip so after 30 minutes we sent her to the ward & tidied up, I was on the 3^rd bust to leave at 7:30. I got back to the hotel at 8 & went by the “hotel restaurant” to see Clover, Cherish & the students. I ate some of their pizza & went to my room to shower only to find out there was no water coming from my sink or my tub. I called at 8:30  they said 30 min but at 9 still no water so they brought me a bucket of “cool” water & I did a wash down. The internet was also out so I did not blog and was in bed by 9:30 which is probably exactly what I needed as I got almost  9 hours of sleep – it was GLORIOUS & I needed it so much!

Tuesday -Surgery Day #2 and More NGO Management :)

Well this is a VERY LONG post again perhaps you will read either the mission or Humanitarian part or both or just skim it but it was a crazy, busy miraculous day that I am so grateful to be apart of.....always AMAZED at what happens on these mission trips....I have had issues hoping it post in some readable fashion

MISSION:  My internet is very unstable so I am writing this post in word & hoping I can copy & paste it into my blog - fingers crossed & prayers up!  It was another very rainy night. I am told the "rainy season" is May/June/July so we are right in the middle of it. Breakfast was supposed to be from 6-7 and the bus was to leave at 7:10 am however with the rain, many of the staff had difficulty getting to the hotel for work and breakfast was not cooked and ready until 6:45 which was right about the time that I arrived at the breakfast room and all the tables were full with team members who had been waiting awhile. The omelet person was not there and that area was closed so I switched up my breakfast plan & had a hardboiled egg, and carb loaded with rice, bread and then added fruit. We got to the hospital and changed into scrubs to be sure the PACU was ready to go & then Abi & I decided to go see the kids from yesterday in the Pre/Post area…here in Africa they take keeping everyone working back in the OR & PACU “sterile” (I would call it clean) so since we were in our “sterile area scrubs” we either had to change back onto our “street clothes” or put on gowns, a hat (over our hat) and show covers – which made us very sweaty - we will not do that again! Instead, we will go there before we change - but it was SO WORTH IT!!! I got to see Jonathan the 1^st baby I screened and first to have surgery yesterday w/ his new smile & his lip looks amazing – I will post before & after photos on my social media. Also, I saw Ella another lip patient & the cutest palate repair with the mom that just stole my heart yesterday and she was so grateful & tearful when I came by to see them which of course made me tearful.

We expected our first cases to get back about 10 am so at 9 am Beatrice and I did some education on Malignant Hyperthermia – a rare side effect more common in African countries and we had a good discussion for about an hour that led into other discussions. I felt like as an “educator” I was on my “A Game” this morning even without much sleep. We had a steady stream of patients and normal calm & chaos. But at 2:30 Della the PACU Intensivist came to me & said a patient is coming off a table with airway issues I need you to take him, set up oxygen, respiratory treatments & let’s see how her does. It took over an hour for Clover the Anesthesia lead & I to stabilize him & he was in a good place by 4 pm.  At 5 pm we only had 2 patients left to come to PACU & it looked like we would get home at a reasonable time. I again offered for part of our PACU team to go home & no takers. I took a bus home at 7 & got to the hotel at 7:20, showered & the cute students text me they had pizza up by the restaurant I truly wanted to just put my PJs on but decided I should go see them and I spent an hour with them visiting & then got my stuff ready for tomorrow. Same schedule as today up at 6 bus leaves at 7. 

HUMANITARIAN: After visiting the post op area, I connected with the “moneychanger” I met last night.  I exchanged the $500 cash & she had large envelopes of money so it must be her “side gig” after social work? I got a low exchange rate that I am certain ensures she makes some money but at this point if she made $20 from me I has 5000 Cedi closer to what I needed for the cash purchases at the market. At 10 am Salam came & we talked for about 45 minutes AGAIN doing all the math- determining what I had in Cedis (Ghana Cash) and figuring out what could be bought & what could be put on my credit card. She had gone by a “warehouse” this morning that had much of what we needed but would only take cash BUT…they would deliver it all to the actual church building where we met Pres. Offari at the district/Stake Offices. That was a big plus because remember that Salam drives a Chevy Spark – there was absolutely no way we could get 39 bags of rice that were each 25kg (about 50 lbs) I her car & it would still run with 200 lbs of rice in it!!! Getting the suitcases took being creative just for space & no weight. The fact they will deliver was crucial. Our plan became to get all the rice, the oil & the cases of tomato paste there as well as large bags of sugar. So, we calculated & allocated cash there first but didn’t have enough cash for all the food. We would also need cash for the city market where we would but the beans, corn & gari. Then we would use the credit card at Malcoms (an actual store that would take credit card) for the rice, oil & tomato paste we didn’t have enough cash for and she scheduled a “tricycle with an open trailer to meet us there at 5 pm and we could pay him to deliver that to the church as well. I am REALLY GOOD with logistics, but this was A LOT and my head was SPINNING AGAIN. I took a deep breath, and I just trusted that we would figure it out - I wasn’t sure how. Bottom line– 3 places to shop cash vs credit card & it all came down to needing more Ghana cash. Patients started coming back to the PACU & I needed to care for them, but my mind was racing everywhere with the question “how to get Ghana Cash”??? We had been talking for 50 minutes & by 11 a.m. 4 patients came back to PACU rapid fire & it was chaos in there with some agitated kids coming out of anesthesia, so I needed to end our conversation abruptly.

By 1 pm things settled down and I was trying to brainstorm how to get cash & actually made a list of options in my mini notebook: 1. Get more at Malcoms – just charge as much as I can don’t worry about the extra expense & we would probably need a 2^nd tricycle & trailer. 2. Check to see if any of the US students had extra cash or Cedis I could get from them & Venmo them or exchange the US cash they had. 3. See if I could use an ATM with my Chase credit card 4. See if I could use my AMEX send account & get money that way or from my card 5. I talked to the “moneychanger” & she had Zelle so I got her phone # to see if I could Zelle her. One by as I made calls options 2, 3 & 4 would not work – CHASE credit card “advance” wanted to charge me 28% plus another fee that was immediate meaning if I went online tonight & paid that cash advance I would already have a $300 fee for $1000 US & that was ridiculous, AMEX was helpful but had no where in Ghana (at least where I was) to access money & I couldn’t even send money to someone (I talked to & considered our PICU intensivist Della) my Zelle was thru the credit union & that seemed the most hopeful until it wasn’t but they don’t have 24 hour service and it was 6 am in CA and their non computerized Member Services opened at 7 am PDT. I felt the clock ticking while trying to manage the PACU & sweet Abi was trying to brainstorm with me too. I thought of “wiring” money to Patience one of the PACU nurses who lives in Ho & has a bank here then she could get it for me, and I text a girl at home I know from the Credit Union at 6:45 her time. I was in full NGO mode while trying to make sure we were managing the patients & I was hitting brick walls everywhere!!!

At 2 pm Ghana time 7 am Calif time I called Member Services at the Credit union – the girl was VERY patient with my scattered thoughts, and we were on the phone for 25 minutes. Zelle to an international bank would not work – I really thought that was the answer, international wiring was also a challenge & could take 24-48 hours to be validated/sent/received. As I was pulling all the cards out to find the different banks phone #s I had seen my ATM card – I never travel with it & rarely use an ATM so the fact it was behind my driver’s license in my wallet was a surprise as I thought I just brought 3 credit cards, my AMEX, a Visa & a Mastercard. I told her I did have that card & could I do anything with it…she said yes it is Visa based & I could use it at an ATM & I asked what the fees were – she said 1% 😊 Apparently I had it set to only withdraw $600 a day but she gave me step by step directions on how to change that to $1200 a day on the app. I asked what if the ATM has a $200 limit & she said I could probably do 2 different transactions. Now I needed an ATM – Patience said there was one at her bank & a friend of hers in another area of the OR & he had a “Pragia” (as his second job) that he happened to drive to the hospital today for work & he would take me to her bank at 3:30 when he got off. It was 2:30 by this time & all sorts of crazy was going on in the PACU (see notes above in the mission section about the really unstable one that  needed to take care of) I had just text Salam to ask her to come back so I could give her an update re the ATM plan not knowing how h I could withdraw but something was better than nothing, it The unstable patient was not stable until 4 pm & Patience friend was nice enough to wait for me after his shift (mind you I had to change out of my scrubs into my street clothes to leave the PACU) & was ready to take me to her bank.  Wait for it…here comes todays lil miracle. As he was driving us out of the hospital, I saw the sister missionaries walking & stuck my head out & yelled “Hello sisters” & he stopped his Pragia & they came up from maybe 30 feet away. I asked why they were there (to visit member in the hospital) & told them I was being taken to a bank downtown to get cash from an ATM & they said “We always use the ATM at the end of this street”. So I said ok will show us where it is. They got in the Pragia & directed us to the end of the street to “their ATM” they said it was refilled with cash on Monday (not sure how they knew that) & I asked how much you could withdraw & they said they often got $200-$300. The USA sister walked up to the ATM with me while Patience friend waited there for us. She walked me thru all the steps of that specific ATM with my card – it offered me a max of 6000 Cedis ($565 American)   & out popped 60 - $100 Cedi bills that I quickly grabbed & put in my pocket as we were in a public area. I told her the credit union said I might be able to do 2 withdrawals so we tried it again & it worked!!! I now had $12, 000 Cedis about half of what I need to buy EVERYTHING in cash if I did another withdrawal in the morning!!! I called them my ATM Angels. If I had left at 3:30 I would have never seen them & if they had not come to the hospital that day & been walking at that time I would have never know about that reliable ATM they used all the time & I am unsure how much money or how confident I would have been at the ATM outside Patience bank. I will say it AGAIN…this is not my errand, but Gods & He is creating the path ahead of me one step at a time. And I was only gone from the PACU for 30 minutes – got back, changed back into scrubs & at 4:30 I text Salam to come I find me I had good news & CASH & could get more tomorrow & told her I thought we could cancel going to Malcoms today & cancel the tricycle & trailer.  She got the message, canceled the trailer & came to see me at 5;30 in PACU & we went into her office and I gave her the full update. The plan now is we will got to the warehouse at 8:30 or so tomorrow morning, after going back to the ATM & buy everything we can there & they will deliver it to the church. The “open market items” will be bought by 2 other sisters on Thursday & Salam & I will go to the “Credit Card” store for a few other items that were priorities on the list for these moms from more “Sacred Funds” sent to me. By Thursday this whole “second miracle filled mission” to my Op Smile Mission will be completed…..I could not have planned or created this whole dynamic even if I tried…it has always been His plan for His children & I am just the facilitator who says show ,me the way to where I should go & what You want me to do.

If you have read this entry  am pretty sure it may be my longest ever…lots to share & for me to remember. Again it’s 11 pm & I need to get to bed   I am truly AMAZED by this day that I was a part of….

Monday Day #1 of Surgery...Home at 9 pm hoping that is an "outlier" :)

It has been a long day #1 - which is typically not how it goes??? Hoping it will be earlier tomorrow night because while I thoroughly enjoyed my peanut butter sandwich for lunch, I just ate peanut butter & crackers for dinner & at this rate may not want peanut butter when I get home - which I rarely eat anyway...For those of you concerned I slept well last night with no leg cramps - Hooray!!! I felt rested & it was great that I had packed everything in my bag ahead of time. I went to breakfast & they have a buffet - none of which I partake of, but I noticed a tag for Gari - a food we will get for the families and it is definitely not a "crackers or a chip"-I am told it is another carbohydrate - so something got lost in translation. My standard breakfast is a 2 egg "omelet" (I use that word loosely) as all they add in are onions & peppers & I have a piece of white or wheat bread & whatever the fruit of the day is - if they have it as they put out 1 tray & then it is gone. Also, pretty sure I will not eat eggs for a few weeks after eating them for 13 mornings in a row...but it does give me a good start for the day and I am not daring enough to et what is in the "buffet" although one of the students said the bean & rice mixture is pretty good so maybe I will try that???  I will again divide this up into sections.... Mission, Humanitarian and Misc for anything else that comes to mind :)

MISSION: Monday starts surgery days and I know the first morning is slow as we have to first go through the mock code emergency drills and they start each operating table one at a time. We have 2 operating rooms here each with 2 tables, so it is a "4 Table Teaching Mission" which also means the cases will take longer as they teach and new physicians are in all the roles - Anesthesia, Surgery etc. I told the PACU team I did not think we would get our first patient until 11 am. I knew that I needed to focus on some teaching & education for the PACU trainees as the "educator & PACU team leader" because nursing in 3rd world countries is very different that in the US and scopes are different and I do want to contribute to their knowledge while we are togetehr for 5 days. Unfortunately, I had not a moment to think about that yesterday & honestly didn't start looking at the Op Smile Academy resources until I was on the bus today but I went thru it and think we can do a lot of baseline education today. 

Back in the PACU we have 4 beds - all have dilapidated mattresses with cracks in them & one bed is so low to the ground it would be hard to manage a patient in it, 2 beds don't have side rails which is a definite patient safety risk (someone literally need to be on or next to the bed at all times & one nice bed. However, they did bring us Op Smile Ghana red & white striped sheets & that made them look nice :) plus some blankets for the patients & the "chux" we need to put under their heads for drooling/bleeding so we keep the sheets clean & trash bags -so Overall I felt better about our supplies as we finished setting up! 

I totally had to pull out & dust off that box in my brain with "mission knowledge & experience" and reactivate it today since it had been in sleeping mode for a couple of years but it all came right back and I also jumped into "full educator mode" did lots of teaching & felt like I co-signed 75% of all the charts today. Della the Pediatric Intensivist is from the PICU at the largest hospital in Accra & he is AMAZING!!! While we waited for patients this morning he & I decided to open up the emergency drug box and review with the other 6 nurses each medication - the type of drug, action, indication etc. We spent 90 minutes tag teamed in discussion& examples & it was great so that was today's education in addition to working 1:1 with the trainees & patients. Tomorrow I am going to review Malignant Hyperthermia - a rare but life-threatening complication especially in African Americans - it has only happened on one mission I have been on and was a mild case but it is a big focus and always important to review the high risk-low volume situations.  

I was off by 45 min the 1st patient got to the PACU at 11:45 and the first wound we all cleft lips (my favorite "easy fix-big impact". Our first round of palates were in there by 3 pm -some of them very unhappy. It was a normal PACU day -slow then 3 patients come all at once & there's a lot of chaos. A few today did get the "extended stay package" if they got extra sedation at the end of the case and it took them longer to wake up as they need to be somewhat "awake" to go to the post op ward. The table #1 team of anesthesia & surgeon was my favorite - they were super-efficient and ahead of all the other tables cases and their patients all came in calm & has easy PACU courses. In fact, when they were finished, I said "could your team just take the last patient from Table 3 because they are way behind & at this rate we will be here late & they just smirked. 30 min later the surgeon was in the hallway & said to me "your wish was granted" :) they took that case but unfortunately it was still a later night. By 6 pm we only had 2 patients left & a bus was returning to the hotel. I offered that 3 of the PACU nurses could go back & 4 of us would stay for the last 2 patients. Abigail immediately volunteered (she is a single mom & brought her baby & her niece watches him at the hotel while we are at the hospital). After that NO-ONE wanted to go - I gave them my best speech about pacing ourselves through the week& still no takers. I think they all feel like they need to stay so they get "good marks" on their training evaluations & I told them that was irrelevant> Then I got frustrated because they stayed but were on their phones & I had to "assign them" in teams of 2 to specific patients. I must be doing something wrong? and of course it is ALWAYS the last patient that misbehaves. Tonight it was a 12 year old boy with a fistula repair (had a prior palate repair that opened up = fistula) and cutting thru old scar tissue = more bleeding. So we watched him closely & didn't send him to post op until 8:30 which led to the hotel arrival at 9. Fingers crossed tomorrow is an earlier return! The power at the hospital went off a few times between 7:30-8:30 & then we heard the thunder & it was storming outside so that was the cause.

HUMANITARIAN: There was not a lot of time to think about this today - which was okay because yesterday the sheer volume of needs overwhelmed me & still does a little too. Salam came into the PACU in the morning & we chatted  & then she came back about 5:30 when she was off work thinking that perhaps I could leave but that was not the case -we said "maybe tomorrow & I definitely need to make that work. I am hoping she comes again in the morning & we can better detail out the "financial calculations" we did re. the needs of the 43 people, and the other things that were mentioned that I my brain turned off as I was in survival mode. 

I did review the plan with Abigail asking her about getting things a "Malcom's" the store vs the Open Market & she & Beatrice looked up costs on their phones & to me it doesn't look like it would be horribly more expensive for the 25kg of rice  - but I understand for people here why spend 60 Cedi more ($5 US) if you can get it for less. To that I say because I can use my credit card :) A lil tender mercy as I arrived back at the hotel & went to the desk to get my room key back. There was just me & 2 other Op Smile folks & I asked the person at the desk if they knew where I could get Cedis for my US dollars & she gave me two bank options that were not close to the hospital BUT the girl standing there said - I can help you exchange money!!!! I asked "are you a "money changer" since that is what they are called & she said no I am the mission social worker, but I am local and have a bank in the area. I was shocked & also not at all surprised. While it seems wildly improbable that of the 80 team members there was one in the lobby with me that could help me with exactly what I needed - I absolutely do know I am "on the Lord's errand" and He knows I need some help!!! So hopefully that will happen tomorrow morning.  When I got back to my room, I texted Salam with the good news, but the text would not go thru (she has an android) and that has happened before so I can't wait to talk to her in the morning.

It's 11:30 & I need to go to bed!!! but if I don't blog every night, I will never blog so I am skipping the Misc category & going to sleep. I am not even going to check for typos or edits - sorry!!! 

LOTS OF LOVE TO ALL who have text or reached out - I am so grateful for your support, prayers, positive thoughts and encouragement as I am on this Op Smile Mission and also equally if not MORE important here to help humanity in Ghana XOXO Nurse nancy  

Sunday - Church & Managing my own NGO or so it seemed :)

 OK PLEASE remember this is MY journal that I make public to those who are interested. That being said...this was really a "non mission day" and I skipped the Team day but boy...I've got alot to say today so if you're bored & have time grab a snack & a drink & read on :) If not pick & choose the categories that you may like...fun fat of the day, church, or humanitarian or none of the above. It has felt like a LONG DAY with things planned but not fully accomplished I have honestly felt like I was managing my own NGO. I went to bed earlier last night & took some melatonin & slept well EXCEPT for 2 times when I work up with immense cramping in my foot & leg one time the right leg & the 2nd time the left leg. I don't know it I was dehydrated or what but it was painful & after I managed the 1st episode & went back to sleep it was awful to wake up again & have it happen twice??? Fortunately, I did get some good sleep in between and I am drinking LOTS of water today.

So last night after blogging & before bed Eddy the PC (Program Coordinator) sent out the next days schedule (for today Sunday) and since they had the AV issue on Saturday for the education sessions they added it to Sunday morning, plus a visit to the shelter (which I would have LOVED) and the team day to start at noon at a Praise Eco center with a zipline, paddle boats & suspension bridge. I text Eddy & told him I had made plans to go to church and meet with some people I have been talking to for about a month to provide some humanitarian help to people in Ho & asked if I could be excused. I already planned for a ride & thought I could be back by noon for the team day (you will see that was not to be) Eddy graciously approved my plans. Cherish dropped by my room & I told her I was going to church to meet Salam & Pres Ofari & she said she wanted to go. I explained how I got excused & told her to LMK. So this morning she said she would join me & was hoping to go from church to the shelter...mind you she does not have wifi on her phone, does not have Ghana currency- so  at breakfast I shared my concerns & uncertain plans but said she was welcome to join me.....

FUN FACTS: People in Ghana seem to have 4 names??? a given name, an English name, a name related to the month they were born in & I will have to get back to you on the 4th name??? So when a  couple from Missouri called Salam Sister Lydia??? I was confused but it is her English name.

CHURCH  -  I went to the hotel "lobby" at 8 to ask them to get me a Pragia for 8:30. There was one arriving just then so they asked the driver if he would take me & he said yes. I text Cherish that we were leaving now & she came. The ride was $4 US for the 2 of us :) Joshua our driver had the address I had on the website & took us to where we thought the church was...& we knew it could be in an apt building but this was not the place. Fortunately, I stopped Joshua from leaving & we called Salam who told him where we should be & for another $3 we got an extra little tour of Ho & I felt like the entire community were all walking to churches & we must've passed 20 churches on the trip. Joshua was super nice & he got us to the right place where Salam was waiting at the side of the road & there was church signage. I kept thinking small branch in an apartment type complex & expected maybe 12-15 people - was I ever wrong!!! Just arriving and walking into church was a GLORIOUS event that felt like "coming home". There are 3 Branches in Ho & they all meet from 9-11 in 3 different places one is a large traditional multi congregation church building that they have had for about 7 years & the other 2 are buildings they rent and have created in them a congregations room for worship & Sunday school plus they have rooms for the children & teen programs. As soon as we walked in numerous people came up to welcome us & ask where we were from & why we were in Ho & I shared about Op Smile which some knew about. They were genuinely so kind. There were 4 missionaries in this branch - two elders from Utah who had both been out a year & they each have African companions - one from Ethiopia who was surprised when I told him I had been to his country 3 times & another from Zimbabwe. Two of them stay "in town" & 2 of them go to the outlying villages & they all loved being in Ghana. They said there were sister missionaries in the other branch. The meeting was getting ready to start & a couple the Grandon's from Missouri came in & also introduced themselves to us - they have been here for 2 years as member & community support & were going home next week. They said when they offered to serve they put in places they wanted to go & Africa was not on the list but they wouldn't change a thing & have had amazing experience with the people of Ghana. During their time here in Ho the membership began at 1600 and has increased to 2360 helping this areas church structure move from a "district" to a "Stake" and the papers have been submitted & in 6-8 months the change will take place bringing these members more resources :) They both mentioned how the people of Ghana radiate the "light of Christ"

No offense to my Foothill Ranch Ward friends but by the time the meeting started the room was full with almost all 100 chairs filled with young & old & all ages in between. The way they sang the opening song #135 about Jesus with such enthusiasm & conviction brought tears to my eyes.  In one row of 3 chairs sat 3 little children all probably under 6 & I was AMAZED at how they sat there quietly the entire meeting while their mother & father sat behind them. There was a steady stream of members going up to share their testimonies - not a break for a minute. An older man talked about how joining the church in 2005 completely changed his life & how he loves God & the church. All spoke in English except for 2 older people who spoke in Twi (which the congregation all know also). Salam also went up so I felt I know her a bit more after that.  At the end a small choir sang Amazing Grace...powerful! After the mtg Pres Ofari's wife had been sitting the row in front of us & turned around & introduced herself & her 8-year-old son who had a Cleft Palate Repair on an Op smile Mission in 2021 - small lil world of how we intersected thru Op smile. He is still in some speech therapy but was very sweet. Salam introduced us to her 3 children - a daughter 22, a son 19 & a son 14. Her husband is not a member of the church but has fully supported her for the 21 years she and her children have attended. He is a teacher at the "state university". We left there after the sacrament/worship service to go meet Pres. Ofari at the 3rd Branch. that meets at the "real church building". Salam drove us there in her old Chevy Spark with no AC & several dents - having a car in Ghana seems to be rare? She also was skilled beyond measure at avoiding all the hundreds of potholes on the roads. When we arrived at the next building the primary children ages 3-11 were singing their little hearts out & oh how I loved hearing that. BUT...Pres Ofari had left that bldg to go see someone at the 1st Ho branch, so we went into Sunday school which went over by 15 minutes & had over 60 adults in class! Church attendance in America may be down but Ghana sems to be thriving!  And we were definitely on "Ghana Time". After Sunday school as we waited for Pres Ofari, we met the sister missionaries at that building - one from Texas & Sis Gransfield from Vernal Utah -they glowed & said this has been an AMAZING journey for both of them. They invited Cherish & I to a baptism that was happening & Cherish went there while I went in to wait for Pres Ofari...who got there about 30 min later but he works in the lab at the military hospital & planned to first do blood rapid PSA tests on all the men over 40 in the congregation. While he did that I chatted w/ Salam & Savior (yes that was his name) the 1st Counselor to Pres Ofari to get an idea of what they were thinking for the humanitarian needs. At this pint Cherish felt like she needed to get back to the students, so we called our Tuk Tuk driver Josh to pick her up & take her to the hotel & I paid him in advance :) 

HUMANITARIAN: If you are still reading - what a devout follower of my mission trips & if you are starting here Welcome to Sundays adventure with Nancy!!! While waiting for Pres. Ofari I asked if they had any ideas of the greatest needs - they mentioned several elderly and widows in the boundaries of the district members & just wonderful elderly neighbors who truly need food. They also mentioned single mothers with meager resources who needed help. That all sounded great. I TRULY have an ARMY of ANGELS who when I leave for a mission trip send me money via Venmo or drop off cash at my home or discreetly give me envelopes of cash at church or mail me checks or even see my post on social media & ask if they can help & this mission was no different & I came with a good amount of "sacred funds" because of the wonderful, caring, kind hearted humans that I know. I call them sacred fund because I feel like I am sent on a mission somewhere & God has a plan or a need and I am just the conduit of their generosity or goodness. I am diligent in trying to understand what I am here to do with thes funds & this time I was still unsure as we waited & chatted. It was about 1 pm when Pres Ofari returned to the room (remember I started the day with an 8 am ride to church -Ghana time :). Pres Ofari had contacted the 3 Branch presidents in Ho & 4 other Branch Presidents in the outer areas of the district & the 3 "units" in the district some of these congregations are 3 hours apart from each other & not in the direction of Accra. He had pages & pages of notes related to the needs, The only thing this made me think about was we are talking about a lot of people here... They also mentioned young men & women who want to do missionary work (most will go to another part of Africa) & they started calculating the amount to cover a suitcase, shoes, clothes & even in Ghana dollars that was adding up fast. They also mentioned Caroline, the wife of the 3rd Branch President who I met at that building with a lil baby on her back & told me her husband is a nurse I may see at the hospital & they have children 18, 14 & 10 & the baby she had today was abandoned at the hospital & since the social workers there knew her husband she asked if their family could care for the baby as there were no resources to take the baby & it would not thrive/survive in whatever an orphanage system is in Ghana ( which sounds nonexistent). With my passion for children I knew I wanted to help her with the expenses of baby formula, baby cereal, diapers & wipes. But after that Pres Ofari's notes from everyone he had spoken to with pages & pages of needs left me feeling very overwhelmed. My last mission in Brazil by the time we met with leaders they had a plan for a specific number of people who needed help with food & the amount it would cost per family & the little miracle was it was the exact amount I had exchanged at the airport. Here I was worried if I had exchanged enough cash & did I have enough for the things they were talking about & how we would get to a decision. I had a thought & asked Pres Ofari to prioritize & he without hesitation said:  "Priority #1 are 15 Elderly throughout the district area without family and without the means to get food. Priority #2 are 24 single mothers some with multiple children who are going hungry Priority #3 were the missionaries, but we dropped the clothes & talked only about suitcases for them. He said these are the 43 people. I felt a little less angst but we were far from knowing what to do, how to do it or the costs. so we got into the details - food for 2 months for the elderly included: 25 kg of rice, 5 liters of oil, 2 cases of tomato paste, beans, Maize (corn), Geri (some sort of cracker) and they could split a large bag of sugar among all. We added costs that Salam estimated & it turned out to be about $100 US per person. We thought we could use those same numbers for the single moms & it could last them 1-1 1/2 months depending on the size of their family. But at that we were talking $4000 and I was very short of that. When we started "ranking the single mothers needs" and who we would skip I felt sick to my stomach. 5 suitcases would be $300 or 3 families but how do I choose?  2 months for a senior & 1 for a family there were no good answers. At least we had a "sort of starting point" which was the elderly. I handed them all the cash I had exchanged & told them I had more cash in US $20 bills that the money exchanger wouldn't take & I also could use my credit card if there were places that would take that but their intent was to go to the "open market" where all of this would less expensive. Pres Ofari needed to leave & Salam & I decided to go to 2 stores nearby to see about using a credit card & what they had. I seriously needed to feel like I was starting somewhere. At the store they miraculously had 5 of the same suitcases for $60 each so I took that as a sign to buy them even though it was priority #3 & I knew I could use my credit card, preserve the cash & which friends would be happy to know that is where part of their money went. That store did not have any baby stuff but the next one did so I spent $100 on that from a friend in Australia after a social media post asked if she could Venmo me $100. We dropped that off to Caroline on our way back   -she & her husband live in Nurses housing by the hospital - they are small brick stacked buildings that look old & word down. I felt good that I was able to get the baby items they would continue to need and likely could not afford (especially since nearly all mothers breastfeed in Ghana but she could not since this was not a baby she gave birth to. I was sensing a bit of traction but it was also 3 pm & I was tired & spent. Salam drove me back to my hotel & we sat in her car & "literally crunched the $$$'s needed" I told her what I had covered & where we might be short. I asked about the price difference between buying the 25kg bags of rice at the store that took credit cards vs the open market she said we would talk more about it tomorrow. I went back to my hotel room ate some snacks as it had been hours since I had breakfast totaled all we could cover & what would be left & PRAYED mightily. I could easily cover the 15 elderly - DONE & 12 of the 24 single mothers or if we changed the amounts, we could give all of them half. It was a lil tricky, but I covered what I could with what we had and shared with my "Angel Army" all the good we were doing. One spontaneously offered to send another $200 via Venmo (if I could get access to it) & another offered for me to spend more & she would give it to me when I returned & asked me to determine the amount & I came up with what seemed right. A childhood friend also offered to send $200 but when she sent me money it was more than what she mentioned & she sent the EXACT amount of money I needed to cover ALL of the rest of the single mothers. Tears FLOODED my eyes in awe of how God is involved and manages the details of all his children's needs all over the world Ponder on this...someone in Calif. sends exactly what is needed for his children in Ghana and I am again simply the conduit for others good. It's been a long day & we still have ALOT of shopping & logistics. I wanted to give Salam time with her family since I occupied her entire day so I text her the joyous news & she said she will get the other 5 or 6 women leaders from the other congregations to help her use the cash at the market & she & I will manage the items we can buy at "the store that takes credit cards" perhaps after a mission night - maybe tomorrow because we are starting with  "light day" of 12 surgeries. It's not all done but it's in process...MIRACLES still exist & PRAYERS are answered & God is always GOOD!  

But quite honestly, I am exhausted & surgeries start tomorrow. It is 10 pm here & I am going to bed - up at 6 & leaving at 7. All my clothes are laid out. I drank water while I was blogging so hopefully, I sleep without leg cramps!!! I know tomorrow will be an AMAZING DAY as we give some little ones new smiles or needed palate surgeries & improve their lives...it's what keeps me going!!! 

GOOD NIGHT FROM GHANA - Nurse Nancy   

Saturday - Screening Day #2, PACU Set Up & a few surprises!

I slept pretty well for being on a hard bed & very overstuffed hard pillow, but I did last night put my own pillowcase on the pillow & believe it or not that makes a difference - a little bit of home here in Ghana! It rained here ALOT last night - no lightening like there was in Accra but a similar loud storm with lots of rain. I suppose that is why it is so green here in this valley. Normally I love the rain, but I am not sure if it will make it even more humid? I was up by 6:15, at breakfast by 7 and the first person on the bus before it was to leave at 7:30 even with a side trip back to my room to get scrubs since we will set up the PACU today :) 

I still started my day with my hair down & thought I would see how long I lasted before ponytail mode! Surprisingly at the hospital the sun was not out & it was cooler & less humid than yesterday - so grateful! There was only about 12 patients waiting when we arrived & we set everything up for screening pretty quickly. There were a lot fewer patients than yesterday and it was much slower paced for sure -but still so many cuties!!! There was a 4-year-old girl who was the sister to a patient & she was a very active lil girl keeping all the students busy & she had the cutest smile. We colored together when I was in between screening patients. There were also a couple of sad stories. The first was a teeny tiny baby I thought was maybe 3 months old but she actually was 7 months & had a cleft lip. She & her 16-year-old mom traveled over 24 hours from a mining town north of Ho - they have been involved w/ Op Smile & seen their nutritionist to try to help her gain weight, but she just isn't "thriving". She can sit up & grabs for toys so is meeting some milestones but also has no hair on the back of her head so perhaps is laying down much of the day. I asked Clover whether she thought the baby would be eligible for surgery & she did not think so because she won't meet the weight for surgery requirement even though she meets the 6 mos. age requirement. he has no caloric/energy reserves for the stress of surgery and the calories needed for recovery put her at too much risk,,,it's such a catch 22 to be in & her mom is so young :(  The 2nd little girl had her lip repaired but still had a cleft palate & a "syndrome" of clefts -her fingers on both hands & toes on both feet & her ears. I am unsure if all these areas were developing & impacted the same way in utero bue she was cute & ran up to me & hugged me whenI was by the play area. 

The surprises...Surprise #1 Vida the Clinical Coordinator came up to me & said since you are the "PACU Nursing Team Leader" I need you to make the on call list Monday to Friday with names, phone #s & rom numbers (which is typical) & since you have Provisionally Credentialed Nurses you would have to come in with them if we got called in....so much for not being in charge...I had no idea I was the PACU Nursing Team Leader & was happy to defer to Beatrice who was happy to be in charge but now that has changed - I am unsure if as the Educator/Trainer I am in charge cause Beatrice is also training or if its because I am on my 20th mission? I took Mon & Wed to be on call & did get all the nights covered. Beatrice will take Friday night since I think I will be heading back to Accra to get my 9 am flight Saturday morning & that airport required you to be there 3 hours before your flight? Fortunately in my previous 19 missions I think I have had to go in or stay overnight 4 or 5 times so I am hoping there will be no callbacks or late nights - if you are the praying type - pray for that please :)

We did go set up the PACU. Op Smile has moved to getting supplies in country instead of flying in cargo like they used too & we would get boxes & boxes of supplies but they would keep them in the are for numerous missions. Today we had ONE black storage box (the kind with the yellow lids) with VERY MINIMAL supplies..."just the basics" is saying it nicely. since all the other nurses are from Ghana they were unphased but my oh my - my brain was buzzing with...we don't have....about 20 things at least. I tried to remember they have all done missions here & medicine here is much different than in the USA - so I am going to have to fix my brain on that too.... We also checked the emergency boxes & at that point I did intervene - if we didn't have exactly what was on the list they wanted to leave that supply out...so a if the list said 3 cc syringe with a needle & we only had them without a needle they were going to leave it empty so I said - "If we have an emergency & need to draw up medications we need syringes & we can have the needles separate"...so there will be teaching opportunities & as an educator that is why I am here. 

Surprise #2 was when we got back to the hotel for the "education day" they had trouble with the AV so we skipped the general session & went into our specialties. some of the PACU nurses were slow to arrive & in my experience the PACU MD has always run those team mtgs. One of the local nurses went up to him to see if her wanted to join us to talk about his preferences & routines & he said that the PACU Nursing team Leader leads that meeting & he would be in the meeting with the physicians!!! So I was also unprepared to lead that discussion but did it anyway talking about my experiences with how to make things run smoothly, working as a team, if ANYTHING bothers you say something, rotation of taking patients etc. We went over the charting, available medications we have, OP Smile Standards for how long patients stay & emergency responses...but it was very "off the cuff". I asked all of them for their preferences on missions, best & worst experiences & that we all will work together for the kids. Beatrice did want us to all review the Operation Smile Academy PACU Pathway for training & we made a PACU Whatsapp group chat & she sent the content to all of us..I have a lil reviewing to do before Monday!!!   

Church Update: Lots of texts today with Salam & Pre Offari - he was in Accra all day - I don't think that is where he works as its 2-3 hours away without traffic? Perhaps he was there on church business? Anyway, he was not returning until late & I THINK I can go to church at 9 am tomorrow in Ho which is his Branch & Salam goes to a different Branch but she will meet us at the Ho building at 10 am. I am very excited to meet with them & talk t them about how we can help humanity in Ho :)

There are MANY churches her in Ho & were many in Accra - I believe Ghana is a very religious country & in fact all day yesterday & today they played what I would call Ghana Gospel music loudly in the screening area on a large blue tooth speaker connected to one of the team members phones. I LOVED IT!!! some of it was in the Twi language & other songs in English. Often times many of the team members were singing along :) songs of praise, songs about Jesus, songs about loving others. 

Funny Moments & Ghana Info: Two of the local nurses came up to me to tell me that they "loved my style" how I tucked my shirt into my trousers & it looked so "stylish & smart". Mind you I am wearing high waister wide legged jeans & an old Op smile T shirt from a previous mission. I simply thanked them thinking that I would always tuck a shirt in with these jeans...then I looked around & not a single other person had their T Shirt tucked in...I would have never noticed that....perhaps I will start a new trend in Ghana or at least here on future missions! 

I did not realize until this morning that they want you to give them your room key when you leave in the morning? They must have a "master key" as my bed has been made each day so they came to my room??? I do recall doing this before in Africa. Problem was I know where my room is but couldn't remember if I was 122 or 123 so I had to have them look it up on the paper Op smile room log. 

FYI there are 2 traffic lights in Ho - one works & one does not. I just didn't notice it yesterday when we drove to the hospital perhaps because the light was green & we just drove thru it?

It is not unusual to see girls fighting girls in Ghana - often pulling hair. Oddly I saw a few from the bus in Accra & didn't think anything of it then this morning at the hospital everyone was looking in one direction & I asked "what's going on" & was told casually  "girls fighting" & sure enough they were. I really need to understand this more???

That's all I've got for today...calling it an early night. I had my peanut butter sandwich for lunch at the hospital because lunch (from the same place & same meal) came at 3 pm. I did take one to eat a bit of dinner in my room but I REALLY want to get to bed early tonight as I am already feeling just a little tired & surgery week hasn't started. I am excited to take my "Tuk Tuk" to church tomorrow & worship with the people here. It is so AMAZING that 7500 miles from home I can go to church and will have some of the same experiences I would going to church at home just with a "Ghana twist" to it :) Worldwide church experiences. LOTs of LOVE  Nurse Nancy 

Screening Day #1in Ho

 I feel like this will be a long post so I am dividing it into "General Mission", "Humanitarian" and "Stuff I want to Remember" so you can pick & choose or read it all if you have time :)

GENERAL MISSION:   Another GREAT day in Ghana with one slight challenge...I got up at 6:30, got ready & had a call with Doug & headed to breakfast about 7:10 planning to eat & be on the bus at 7:30. SURPRISE!!! The bus left at 7 am???? There were still about 30 team members at breakfast to take the 2nd bus at 8:30 but nurses were supposed to be on the 1st bus...I was beside myself stressing out...in 20 missions I have never missed a bus...and the paper schedule said 7:30 & I thought that is what they said last night at the team mtg. but I guess it was 7 am. Unfortunately, I had the audio on my WhatsApp turned off (too many messages yesterday) otherwise I would've seen the message they were leaving at 7:15 instead of missing it. I know that getting set up for screening is ALOT of standing around but I still felt awful & asked if I could take a taxi but we are too far out & Princess (name of one of the coordinators) kept saying "don't worry its fine". So I took some deep breaths & reminded myself that I'm in Ghana and as we saw yesterday time is sort of relative but not usually on missions so not my finest moment...there were 24 of us on the 2nd bus including my trainee Abagail & Livingston another nurses, Clover my Anesthesia friend, and the Medical director of the mission - so I was in good company :) It was only about a 15 min drive to the Ho Teaching Hospital Campus down from the big hill where we are staying. Ho is fairly large but much smaller than Accra-less busy, less stands, (only a few open this morning), fewer people out walking, lots of churches 

I got their & they were set up for screening but were just starting patients. I was helping take Vital Signs & SOOOO MANY cute babies needing lip repairs were there with sweet mamas. I will post some photos on my social media. There were also quite a few palates & some older teens/adults. If we do 60% palates that could be 35 or 7 a day which could make for long nights - we will see!!! They do have a patient shelter here and some families have traveled 14 hours from the northern part of Ghana to be here. seeing transportation options, I am certain for many it was a difficult journey. With so many at the shelter a small bus would bring about 30 patients at a time & drop them all off with their parents where they would then start the screening process getting registered & going thru 12 stations that probably took them 3 hours minimum. Then about 2 hours later they brought a 2nd group. We stayed very busy from 9 am-2 pm between vital signs & getting a height & weight on each of them. There were a couple of sad cases an almost 2 year old with a tumor on her tailbone that of course Op Smile can't help but people hear there are free surgeries not know its a specific type & of course seek out help for their child :( We were able to give them a very solid referral for The Mercy Ship which will be here in early August.  

There were SO MANY things I had forgotten about Africa...the hospitals are a bunch of buildings with open windows, maybe fans for air circulation & all connected by outdoor walkways with outdoor grass & benches where family members sometimes wait. So I expect it may be a walk to get to the post op unit. I also forgot how humid & hot it is even in early June - I lasted about an hour before I put my hair in a ponytail. I also forgot that we are in a high Malaria region...they may have suggested prophylaxis but I may have ignored it because other than my 1st mission to Kenya I have never taken it but tonight Clover mentioned she needed to take her Malaria medicine because she forgot yesterday & I said "do we need it" to which she said "Absolutely" even though I haven't seen any mosquitos here. So little blessing for me Cherish got a prescription with 30 pills so she gave me 10 & I started taking them tonight. 

Two of the "Tribal Chiefs" from the area came by to see what we were doing as members of their tribes were here as potential patients. They were in tribal fabrics tied over one shoulder...very interesting - no photos taken the last thing I need is to make a tribal chief upset. They do have a local language "Twi" that many families spoke as do the local nurses. 

Mission lunches are always interesting - since I declined one yesterday Princess was insistent, I go get lunch today...3 choices a vegetarian, a spicy fish (head or tail still on) & chicken. Several others had eaten the chicken & the meals were in a nice container & a bag from a local restaurant with a handwipe & silverware, so it seemed legit. There was enough rice for a family of 4 & a chicken leg/thigh combo. I pulled off all the good chicken meat & ate a little rice to the satisfaction of others concerned about my eating & kept my peanut butter & bread in the bag for a sandwich tomorrow :) 

There was a lot of confusion over who should be trained for credentialing in PACU as one local educator canceled at the last-minute leaving Michael without a trainer & another local volunteer Sarah came & needs another credentialing shift. This was way over my decision making so I emailed Karina the Op Smile Academy Director letting her know what was happening & asking if I could train 2 people. She emailed back right away, put me in touch with Eddy the Program Coordinator on the ground here & long story short come to find out Abagail already had 2 successful trainings in her last 3 missions & should have been marked as "provisional credentials" only needing a skills check off that the Clinical Coordinator can do but her on line file was not up to date. Michael & Sarah both need 1:1 training & I can only do one at a time. So, I will train Michael & Sarah will have to be an "observer" which is heartbreaking as they are taking time away from work to be here. The missions here are 1-2 times a year so it can take a while to get credentialed. Had we not gone down this rabbit hole I would have been with Abigail who did not need another training mission & Michael would have been here planning to train without a trainer.  It all worked out as it should have :)

By 3:30 we were done screening 59 patients but 24 were still in the queue to finish some stations - since we were "Station #3" & done we packed up our stuff & came back on the 1st bus. Tomorrow we will actually leave at 7:30 (so up at 6:30) screen until 1:30 then come back to the hotel for the education session from 2-5 pm

HUMANITARIAN/CHURCH: I have continued to text Salam (Sis. Kassah) and Pres. Offari and about 2:30 during a lull and after the credentialing chaos Salam came to find me. she is a CRNA (nurse Anesthetist) at the hospital & said she that while she is not part of the mission, she will likely see me each day as she and I will be near one another in the operating & recovery areas so that was a fun surprise! We chatted about the needs they have discussed - several elderly in the community who need food support as well as some single mothers. I gave her examples of needs in other countries & told her to determine the needs & my "tribe of angels were ready to help". We will likely get together tomorrow night or Sunday. She may have the couple missionaries pick me up as I have no transportation options. I introduced her & Cherish & Cherish brough some water purifiers to give away & other items. AS we sat & talked I told her "I don't know what is needed here - that is for you & Pres. Offari to determine but of all the mission options I had this was the only one that worked & that I was selected for so I know I have traveled 7500 miles to Ghana for a reason- anxious to understand what that might be...

A local Op Smile employee Kofi Takorah from Accra came up to me and asked if I belonged to the LDs church & said he goes there too. As we talked, he mentioned growing up in an evangelical church talking to missionaries on the street and going to church with them & "feeling Jesus there". He knew the Bishop and wants to get baptized but part of his job is to travel to remote areas on the weekend to find children with clefts to come to missions for help & he has been busy preparing for this mission and not able to go to church but he will be going every week when he returns to Accra & will then be baptized. He was so nice & we talked a lot about Jesus.  

STUFF I WANT TO REMEMBER

A few Ghana "fun facts" 

After getting back to the hotel I was sweaty & desperate to shower - my room has a tub & then a shower handle that attaches to the wall pointing out of the shower. The "climb" up into the tub is honestly 2 feet high & there is no shower curtain. I had 1 bath towel & 1 hand towel, so I decided to sacrifice the hand towel to become a bathmat in order to not slip & fall or slip stepping 2 feet down on a wet tile floor out of the tub/shower. All was well.

In Ho there are not Ubers but they have the small Tuk Tuk motorized  carts that can carry 2 people that are in many 3rd world countries (here they are called Pragias?) After much deliberation several of us decided we could perhaps try to find a ride on one of those down the hill but were not confident we would get back up so we skipped that idea & ate dinner in at the hotel. 

Sadly, yesterday as we drove more thru the city of Accra as we stopped there were still the "street vendors" but also darling children smiling at us in the window & begging for money...it is typical in a 3rd world country I know but always so heartbreaking

Their version of "public transportation" in Accra is there are TONs of very old vans (normal size) with 5 rows of 3 seats across (including the driver's row) so 15 people & everyone with their big bags are squished in these vans. From what I was told they are at the side of the road & have a planned route depending on who gets in & then when they are completely full (I have not seen a van with less that all 15 seats full) they start their drive & drop people off - not sure if they add more riders along the way - it is wild & according to Ruben my hotel drive very inexpensive but miserable...I am sure it is better than walking though?

That's all for today - I feel & appreciate the prayers & good thoughts from 7500 miles away more than I could possibly articulate. So grateful for friends & family.