Pictures of Henry

Henry is still here on the ward. His wounds (from a severe dental infection that almost took his life) are healing and he looks so much better than the first day I received him in the ICU almost 3 weeks ago.

Henry spends most of the day just sitting around waiting for the day to pass, but during the week he goes up to deck seven and plays football (soccer) as his Occupational Therapy. I went up the other day and we were teammates and pretty much won by a lot.

A Walk To Beautiful...

Stephanie and I both saw a movie here on board that will soon be playing on PBS in the states, which I will soon give you information about.  http://www.walktobeautiful.com/   -  http://www.fistulafoundation.org/movies/screening.html  We were able to view and see the movie because of Dr. Steve Arrowsmith (who is currently here on board).  Bio available here at this link: http://www.globalhealth.org/pop_ups/events/steven_arrowsmith.html

We would both strongly recommend you see this movie, it is not Mercy Ships affiliated except for Dr. Steven being Vice President for International Program Development for the Worldwide Fistula Fund, and we do these same surgeries here on board the ship for the women of West Africa and in a clinic in Sierra Leone.  This movie will definitely help open your eyes to life changing operations that we have eradicated altogether in richer parts of the world.  Fistula what?  What is that?

I (me Tyrone, being the guy that I am) was even moved by the emotion and power that this one surgery or hope that these woman have can mean so much...so its not just for the women to watch or understand!  And even how sometimes it takes more than one surgery!

Broadcast Premiere

• NOVA on PBS
      May 13, 2008 -  Check your local listings or go to pbs.org for details

 

Cooking Teams (#2)

If you missed the first installment of Cooking Teams you can catch up here.

My role as Chief Cook/Lead Chef (the title really does seem to change on a whim) sounds good on paper.  The reason I say that is because on paper my hours are from 8 to 5 Monday thru Friday (Riiiiiiiight).  I guess it could be in certain circumstances or if I really didn't care and wanted to get on with life outside the kitchen, but I am one of those people who love it.  I usually stay hanging around the kitchen thru to 6 or 630pm just to see things thru or just do some recipe research or the small 'pushing paper' part of my job by creating menu's or questions to bother my boss about, he loves it. (I am being sarcastic)

In the past we had some special events, functions, and dinners which usually involved me working on the weekends, and if you are actually on the ship when are you really ever off from emergencies and unknowns?  Believe me, a lot of unknowns or surprise things need to be done that involve guess what?  That's it, the galley!

If you remember me talking about the earlier schedules of the cooking teams in my last post you will see that my schedule has me working with both teams thru out the week (remember team Fried Chicken and team Watermelon?).  Oh and by the way, I named the teams not to be cliche (ok maybe partly because I thought it would be funny) but because I actually like both of those foods allot...although I try to keep my fried chicken intake down for all the obvious reasons.  Being able to consistently to work with both teams on and off thru the week really helps me to keep a good handle on things and to see both strengths and weaknesses in each team.  And that in turn helps me to know how to menu plan, clean, cook, and get organized in the kitchen/galley depending on the character and quirks of the team working.

Now that most of the special events or food functions have passed away I may actually have weekends off...BUT the joy in that is now I can start 'hanging out' or signing up for other projects and events.  This weekend I have signed up to go out Saturday to help work on construction projects for a local orphanage, Stephanie has also signed up for a totally different project than mine and she will get to visit with handicapped kids (& maybe some adults) at a home.

Hope in the Hall

I was walking in the hall from the kitchen to D ward when I stopped abruptly and was overcome with emotion. There were about 10 Liberian women, patients on A ward, walking toward me singing "I have hope, I have hope, I have hope in Jesus." These are the women that are having VVF surgery.

VVF stands for vesico-vaginal fistula. During prolonged labor pressure from the head of a fetus can cause internal tissue to become necrotic (dead). A fistula develops between the bladder and vagina and causes a constant leak of urine. More severe fistulae may include the rectum and feces will leak as well.

Western medicine has eliminated this condition in the developed world. But in Africa, at least 2 million women are leaking.

They leak because girls are forced to marry before they have fully developed pelvic bones. They leak because their bodies are malnourished. They leak because maternal care is not accessible. Often, a woman will endure five to six days of unattended labor. Her efforts produce a dead baby and a solemn memorial. It is insane to me that 1 out of 16 children die instead of live during the birthing process in west Africa.

Last night as these women, with their catheter bags in their hands, walked down the Hall of the Africa Mercy Hospital singing with a smile on their faces "I have hope, I have hope, I have hope in Jesus", I was reminded that I have a lot to learn.

Ciatta

Tuesday evening I was assigned to D ward and I had one of the Academy students (the school for the kids on board) as a job shadow. KimAna's family served on the Caribbean Mercy when we were there and now are on the Africa Mercy. She is 15 and is interested in being a nurse, she will be following Megan and I for 7 shifts. We received report, started our assessments, charting, vital signs, and of course held the babies.

Around 5pm we heard that we were getting an ICU patient with a Dental infection (big surprise). She came in and was having a hard time breathing. All the Doctors came in and we got her ready for emergent surgery.

We went to dinner and when we got back the patient was on her way back. Her name is Ciatta, she has 4 children and a husband for 13 years, that loves her so much that when he saw her after surgery he threw himself on the floor out of despair. Ciatta came back from the OR still intubated ( breathing tube in her nose and on a ventalator). We got her settled by putting her on sedation meds ans morphine for pain control. We placed all the tubes that are normal for a intubated patient. KimAna got to see a lot.

 The next day we both came back bright and early for morning shift. Ciatta looked much better. By late morning we started taking out all the tubes we placed the night before, including the breathing tube. Ciatta made a wonderful recovery. She sat up in a chair and was even transferred out of  the ICU.

At the end of the day I was blessed by Ciatta. I got to see the whole process including the recovery, what a blessing.

Yogurt!

I have had quite a few comments about yogurt but here is a general reminder:

Yogurt is like oatmeal, if it's done it will be a volunteer that will have to work around our limitations. I know maybe you have been in our kitchen/galley...if you have, you see our galley is even smaller than the ANA with more people to feed.

Last I heard someone was supposed to take over for the last person who was making it volunteer-ely (if that's a word) doing it on the weekend out of the way of the cooking teams & dining room working hours.

Also, we (galley/dining room) are not in charge of any part of it and can not be pulled away from our work hours to assist you, every working person in food services is precious and their time during work is precious...if you would like to be that volunteer you need to contact a previous volunteer that can show you how to make it, take care of it, and overall be totally responsible for it within the basic guidelines AND permissions for galley and dining room use. (because the warmers that are used for the yogurt are in the dining room).

Otherwise, you are free to enjoy the yogurt cups that we supply from time to time...no it may not have that 'fresh made' yogurt nutritional health, but it does taste good every now and then when you really start missing that yogurt taste!

B is for Baby

One of the weird things (there are many) on the ship is that even on your time off you hear about the new patients, the emergencies, and the funny things that are going on in the ward. When you live literally 200 feet from the ward it is easy to go down on my time off to see what is going on. Earlier in the day I heard we got 2 more babies on the ward. Actually, it is the mom who is having surgery, but the 2-week old twins are with her. I walked down to B ward and was taken back when I opened the door and heard 3 babies crying. It was music to my ear, mostly because I knew that I would be able to hold one of them. I picked up Anthony who is 10 days old and he instantly calmed down and nestled into my chest. He was brought to the ship when he was 6 days old with a condition in which his spinal cord was exposed in a little sack and was becoming infected. Now, little itty bitty Anthony is on the ward. after his surgery a couple of days ago, getting antibiotics and spoiled by all the nurses that crave baby time like I. Stephanie

Cooking Teams

The team setups for cooking are a bit unusual but they work. I'll explain. The baker kind of has his own hours that usually start way early in the morning and finishes up around midday...nothing really unusual there. Right now the baker takes Wednesday and Sunday off. Before the baker used to take the weekend off but made sure and had enough backup bread in the freezer to last thru the weekend.

Then we have 2 or 3 people on salad team which usually runs 8-5 Mon-Fri. But our cooking teams, of which we have two, work 2 on-2 off- 3 on- 2 off- 2 on- 3 off...confused? It looks like this. Team one works Monday and Tuesday, then Friday, Saturday, Sunday, then Wednesday and Thursday of the following week...that's a two week schedule. Team two works the alternating days. Their schedule on each team starts at 8 in the morning and ends about 7 at night. Oh its not that bad if you think about it...two fifteen minute breaks one at 10am and another at 3pm(approximately) then usually an hour for lunch and an hour for dinner.

We also have devotions (devo's for short) or some kind of meetings every morning Mon-Fri so that is another half hour deducted from actual physical working time...and they do work hard! But if you subtract the breaks, lunch and dinner break, and devo's you eliminate 3 hours from the 11 hour shift which brings it nicely back to an actual 8 hours physical work time. The stress and heat of it can can make it feel like 12 hours straight sometimes.

In addition to that at least one person is dedicated to being ward cook on each team (cook for local patients on the ward) because if the locals ate our food it would probably give them some extra grief adjusting to a new diet so we have a local person cook local food for the locals, sounds like it makes sense doesn't it? (at least locally right?). Also a dedicated dishwasher (this usually takes two sometimes) and two storeman because a crew and local workers of this number/multitude eat a lot of food and we don't have the privilege of ordering food every week from a local supplier who can meet our demand. So most of our stores are in months supplies stored in the bowels of the ship. Including 4 walk in freezers and a walk in cooler/fridge/reefer as well as a few upstairs (mini versions).

Back to the teams...

Instead of calling them team one and team two, lets change the name so in case they read this post/blog they won't start teasing each other about who's number one and number two.

Right now we are actually staffed right in the galley, dining room needs more workers.

Team Fried Chicken consists of the following nationalities: Ghana x2, Guinea x1, Canada x1, Australia x1, Liberia x2

Team Water Melon consists of the following nationalities: Australia x1, US x1, Ghana x1, Guinea x1, Hong Kong/Canada x1, Liberia x2

Salad Team consists of the following nationalities: US x1, England x1, Liberia x1

Storeman consists of the following nationalities: Ghana x1, Canada x1

Baker consists of: Germany x1

So you see its a very diverse group of teams I work with daily, and its constantly changing.

I'll get more into my role later on...don't want to put you to sleep all at one time.

For all the coffee lovers...

Coffee Art

There is a restaurant in Vancouver ..actually three
where they dress up the lattes.

You get to watch them create the pictures.

(thanks Carol for passing this one along!)

Welcome to the Ward

Here are some pictures of the ward patients. The little boy is Adolpho. He had a mass removed from his ear. He is a very rambunctious child. He played with a truck constantly, supporting the theory "boys will be boys" even in Liberia. The little girl is Godgive (yes that is her real name). The rest are of the ward nurses getting "handover" and of various other patients. We are not allowed to take pics on the ward due to patient privacy, these are the communication departments' pics, hence the watermark.

Henry

Henry is a 21 year old guy that was brought to the ship from a dental clinic about 8 days ago after he pulled out his own infected tooth.When he was brought to the ship he was in bad shape. His heart rate was in the 150's, his blood pressure was low and he was really struggling to breath. The infection had taken over his mouth, jaw and right chest. He was brought to surgery emergently and they cleaned out the horrible smelling stuff that was killing him.

I received Henry from the recovery room and he had 14 penrose drains (drains that allow the exudate to leave the body to get rid of the infection) in his mouth and chest. Over the next couple of days I spent countless hours with Henry, changing his dressing, starting IVs, giving him meds, and just trying to keep him comfortable.

On Sunday and Monday they took Henry back to the OR to clean him out again. As of Sunday morning Henry was not looking good, I was starting to think maybe we would loose him too. All of this time Henry was quiet and very stoic. But on Tuesday I came in to take care of him, I almost started to cry. Henry was sitting up in a chair, the drains in his mouth were gone. I think I actually screamed in excitement and Henry started to laugh. Woohoo!! That to me was pure joy, to see a boy that was so miserable and incredibly sick, laugh. Henry still has a long way to go. His wounds are very open and really need to heal. Please pray that Henry will have no more infection and that he will recover quickly so he can go home!!!!

Pink Meatballs, Pasta in oil or butter

I have had the report back that some of the meatballs were pink in the center...alright, fair enough.  But let me give you a little bit of education and science behind some of the things and preparation we do.  (because it didn't bother some people)

The meatballs were first boiled for 20 to 30 minutes to quickly set the shape of the semi-ball form (we don't have the luxury or time of making them machine produced perfect orbs, I am sure you already know that so we will move along) and additionally to boil off and leave behind meat juice 'residue' and fats.

Then the meatballs are cooked at about 325F or 160C (roundabout proximation) for about an hour.  This tightens up the structure of the meatball as well as colors it with a better roasting brown (thats a color for you to request at the paint store, roasted brown meatball - it works well with a burnt caramel, or creme brulee on the molding and trim).  In addition to this it completely cooks the meatball.  Then I check the temperature for at minimum for 160F (71C).  Then it is held in the warmer/oven for an additional half four or more before being served on the line.  Sometimes meat can be fully cooked and still appear pink, this is true with smoked meats especially.

Another example is science that most people will not accept because their upbringing or knowledge will not allow them to...that is that meat can be cooked to a varied (depends on kind and cut of meat) temperature for a certain length of time and not be well done, BUT STILL has been cooked to the appropriate specs allowed by government regulations.  Which is the standard that most of the world goes by that has these health governing agencies in their country.  Some exceptions are of course fowl, more specifically (in our situation) turkey and chicken which internally should/has to be 165F or 74C.  Most of my specs are drawn from the food and drug administration.  Here is a link if you are interested in this: http://www.cfsan.fda.gov/~dms/fttmeat.html or here http://whatscookingamerica.net/Information/MeatTemperatureChart.htm 

But of course, you and I both know I couldn't have or didn't check every meatball. (laughing)  Just a few in different batches.

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Pasta!  Some of you may want to argue when I get done with this section but putting butter or oil in the pasta water doesn't really do what you think it does...I say its 50/50 (and food science backs me up with plenty of experimental statistics to prove it) and the experts say its 0% that oil or butter in the water actually helps the pasta not to stick together in the water.  Its one of those old traditions that was handed down and taught to everyone so long its hard to change the mindset.

From my experience and all the food science books I have ever read all you need is the proper amount of water per pound of pasta, a high enough temperature for cooking it, and salt in the water (for taste, not the silly change the degree in the water explanation, because even if it did what use is 1 or 2 degrees difference?).  Thats it. 

I have talked to Italians, Chinese (because supposedly they had the pasta before Italians but I won't be in that argument) and worked for a 'boat load'of chefs that all agree, water and salt.  Here on the ship I cook the pasta without watching it all the time.  A few stirs here and there, my pasta comes out beautifully time and time again...and when I teach it to others they have the same experience, no oils or butters.  No sticking.

So what does the oil do?  In the water it will attach itself to the pasta but not consistently because of the moving boiling water.  And then when it does it 'seals' the pasta so to speak.  What is the outcome of this?  Ever had that plate of pasta bolegnese or spaghetti and meatballs only to have watery sauce in the bottom of that plate?  Yep thats what it did, locked the sauce out of soaking into the pasta.

Now, all that being said...I add olive oil (when available, its extra virgin 'the good stuff' right now) after the pasta is in the pan, yes it still locks out some of the sauce from attaching itself to the pasta but this is the compromise:  When you are at home and want to add the pasta straight into the sauce or vise versa and eat it right away I would never use an oil or butter directly on the pasta, because the fresh cooked pasta will suck it up like a child and a milkshake...BUT when you are feeding 400 plus people that little drizzle of olive oil mixed with the remaining wetness of the noodle keeps the pasta from sticking together in big clumps while it sits on the line.  So a compromise is made for the best.

I will only add additional oils or butters (besides the drizzle) if I am applying some herbs or flavors to  the pasta...otherwise, NO I do not.  Although our cooking teams may decide to cook things differently this is my standard.

We should stand on that rock

Going to the market in Liberia is always an adventure, well leaving the ship at all is an adventure. Yesterday, Jen and I both were canceled from the ward, so we decided we would be brave and go to the market. We walked through the gates of the port and entered Africa (on the ship we are next to Africa but not in Africa). We stood by the road with our hand out, kind of waving in the direction that we would like to go, hoping that a taxi would stop and take us to the market. We stood there feeling very silly and watching taxi after taxi whizz right by us, with at least 7 passengers already in them. Then, a Mercy Ships Land Rover stopped and gave us a ride. It worked out perfectly. We then walked towards the "market" , I use this word in-quotes because it is by no means is anything like any market I have ever been to. It is a myriad of storefronts, Wheel Barrel stores ( a guy has a wheel barrel full of one kind of merchandise), and tarps of stuff on the side of the road. In some areas, it seems like a Liberian form of a mall. There are inside stores with lots of stuff and some of the stores are even upstairs (well up these uneven concrete things that kind of look like stairs). There are many things sold at the "market", we bought fabric, a serving dish (for my cookies that I often bake and share with friends, it actually looks like something from the summer collection from target), and Jen bought flip flops (slippers).

At one point we turned onto one of the side streets and there was a median-like structure in the middle of the road, but unlike our well-manicured western medians, it was actually a make-shift dump.

Once we accumulated all of our treasures and had enough hissing sounds and "white girl, white girl I love you!" yelled at us, we decided to venture back to the Ship. We needed to catch a taxi, which seems pretty much impossible. We tried a couple of different places, with our very best taxi catching wave with no success. So then we saw a large rock that we decided was a good idea to stand on so the taxis would see us better and then would definitely decide to stop. Many people just laughed hysterically and kept driving, but one taxi actually stopped and let us in.  We got almost to our destination when we figured out that this taxi was being chartered by a woman. When they got to the point in the road where they needed to turn and we needed to go straight we got out and the woman said we didn't have to pay.  What a blessing, we made it to the "market" and back to the Ship without even paying for a taxi.