Day 497 or The Nose Job

One of the many benefits of living on a hospital ship in Africa is that during field service, the hospital lets us come down and watch surgeries. It’s all carefully done, of course, with sign up sheets, scrubs, mask, shoe coverings and sometimes goggles.

Last year I got to watch both cataract surgery and pterygium sugary. Cataract is when the lens inside your eye because cloudy. They take it out and replace it with a small plastic disc. Pterygium is when the white of the eye begins to grow over the iris and has to be cut away.

After seeing surgeries on eyes, I figured I’d be set for anything.

I was wrong.

I arrived, right on time and after a few last minute things, was brought into the sterile hallway. Alex checked the three rooms currently running and found the last one to be ready for visitors. The room was cold, air conditioning going strong, and the whole thing felt as sterile as it was. The table was covered with blue fabric with one slit in it, exposing a small, thin leg. There was a new cut down the middle where the ball meets the heel. One of the nurses explained to me that the foot was stuck in an unnatural position and needed to be moved. They also were going to take a tendon out of their ankle. I watched as they made the second cut, then, after locating the percises one, began to pull the tendon out of his/her leg. Pull. The pure white tendon. It had only been a few minutes before that I had noticed that I no longer was cold. I wasn’t even cool. I was in fact, quite hot.

I let myself out with the lame excuse of “I think I’m going to see what are in the other rooms.”

After a few minutes of standing in the hall, I was joined by one of the nurses. At first I thought she was coming to check on me. Instead she leaned against the wall and put her head down. We talked for a few minutes, neither really understanding why we couldn’t handle it.

I excused myself once more, though I felt better knowing I wasn't the only one.

After a coffee and a bit of reading, I decided to try again. I went back to the OR, back on went the hat, back on went the mask and boots. We got to the hall again and Alex said “Do you want to see the head surgery?” Maybe that was a bad idea. I agreed anyways.

We walked in, the cold air greeting us once again. The patient, a young woman, lay sedated on the table, tape over her eyes, an air pipe in her mouth and a four by four inch square of her skull exposed. They had made two slits and folded it back to work. They had already done most of the drilling and as I walked in, they finished and pulled out a chisel. The nurse explained to me that they were going to take a layer off of her skull and put it in her nose. A layer of her skull and put it in her nose!

Apparently this young woman had come to the ship in 2002 for issues with her brain not being the right place. Mostly being inside her skull. They had fixed it, but her nose had almost no support, leaving it quite flat and fleshy.

The anesthesiologist told me that if I moved to the opposite side of the room and stood on the stool, I’d be able to see more. The view was amazing. From this side, I could see that they had made about a two inch slit down her nose, starting about where the eyebrows meet, like a gapping mouth between her eyes. The doctor tried out the bone, sliding it through the slit and down her nose. Examined it, then took it out to be trimmed. He shaved it down, trimming and smoothing, then slide it back in. Pleased with how it looked, he pulled it back out and began asking the nurses for equipment I had never heard of.

Allison started doing something I didn’t understand, pushing a thin metal screwdriver into and out of a plastic box. I then realized she pulling out screws, tiny tiny screws. A small piece of metal they called a plate, but looked to me like the metal version of those rubber bands they use in the orthodontist, the long ones they use to connect all the teeth together, was passed over and he screwed it to the top. He then placed it in the nose once again and screwed it to the bone. About that time I looked at the doctor. He was concentrating hard, completely unaware, or maybe he just didn’t care, of the shreds of bone that covered his shirt and the blood that smeared across his stomach.

He went back to the top of the head and cut a thin sliver of the flesh underneath and pushed it too into the hole in her nose. The stitches were passed to him and he tied the newly moved flesh to the inside so that it wouldn’t move. He then moved back to the head and began to stitch it up. One stitch in the corner, tying it all together, then three single stitches down either side. He then asked for the stapler and put six staples up one side and seven down the other.

He moved back to her nose and stitched up her nose. Allison squirted a goop that reminded me of marmite and smeared it across the staples and stitches in her head. Which of course led to an interesting discussion of “Which food item does this remind us of?” The answers were carmel, marmite and nutela.

I took one last look around the room, the tools spread out, the rags with the blue strip that show up under x-rays, the clothes and the staff. One last look at the girl, the flat nose now stood up with a pretty little tip, the tape over her eyes and the staples down her head. I thanked the staff for letting me watch, then I left.

Day 475 or Part One

This is the offical statment that Mercy Ships has released to the public involving the screening.



Mercy Ships is deeply saddened by the tragic events that occurred today during medical screening at the Freetown National Stadium when a crowd stormed the gate resulting in several injuries and one life lost.

Mercy Ships personnel working at the site attended the injured and accompanied them to local hospitals.

"Our hearts and prayers are with the individuals and families of those affected by today's events. The occurrence of this incident in the course of activities intended to restore lives is tragic. We move forward with tremendous sadness, but great determination, to assist as many people as possible in the next ten months," stated Mercy Ships Founder, Don Stephens.

Mercy Ships exists to serve the forgotten poor and has served Sierra Leone five times over the past two decades, also helping establish two land-based health care facilities. For the next ten months, Mercy Ships will be providing surgeries for qualified patients while working alongside the Sierra Leonean Government to support its five-year healthcare plan and strengthen the functions of the national health system.



Please keep the people of Sierra Leone and the Mercy Ships crew in your prayers, not just today but in the months to come.