Transformation: The Checklist.

31 January 2015

If you want to see me get passionate about something, ask me about the Checklist.

The WHO Safe Surgery Saves Lives - Safe Surgical Checklist (aka. the Checklist) is a tool that was developed by the World Health Organization (a bunch of really smart people) a few years ago.

The WHO version looks like this:

If you've had surgery in the half decade or so you will recall being asked several times on the day of your surgery who you are, what you are having surgery on, etc.  When they asked me those questions before shoulder surgery a few years ago, I thought to myself, "huh? aren't you supposed to know this?" well, now I understand - they DO know it, they are just verifying it, as a part of the checklist.


Because we are all human. And humans, by very nature, make mistakes, forget things, or make assumptions.  The example my friend and colleague Michelle always uses is we know we are supposed to floss our teeth. We know it's a good thing and it's beneficial to our health for numerous reasons. However, we don't do it every day.  After we go to the dentist we might be good at it for a month or two, but eventually, we skip it one night or forget one morning. The same is true for washing our hands.  We all know the benefits of washing our hands, but do we do it enough? Probably not.

So if you take that to the medical arena, what if your surgeon misread your chart and took out your gall bladder instead of your spleen? Or what if the anesthetist that met with you the night before falls sick, and the replacement doesn't know you're allergic to a certain drug?  Or when the gauze they use in surgery gets bloody and they can't see it, and it gets left behind in your body? These things happen, and if you do the research, it happens far too often.

But that's the idea behind the Checklist.  Read this book: The Checklist Manifesto.  It's written by the guy who spearheaded the writing of the checklist, but it's super applicable to just about any job. I've started making checklists for just about everything - because we can't be expected to remember everything, all the time.  Trust me, you will be glad you read it, no matter what arena you work in.

But I digress.  So that's my lay-reader version of what is the checklist.  Why is it important? It's been PROVEN to decrease operating room mortality by about 50%, and complications and infections dropped very significantly as well.  And it isn't fancy, expensive equipment, or new drugs, or huge investments of time or capital.  Meaning it can have as significant an impact in Minneapolis as it does in Nairobi or Toamasina, regardless of resources. (Read more about the Checklist and research to it's effectiveness here: WHO Safe Surgery)

So with all that you are probably thinking "well, that seems simple enough. Just tell people about it and they will use it!"  ... if only it was that easy.  Behavior change is hard, and just because you know you should floss your teeth doesn't mean you actually do it. Just because you know you should use a checklist before surgery doesn't mean you actually do it.

So one of the big projects we are working on as a part of our medical education program is trying to figure out how to implement the checklist.  How can we go beyond just explaining why it is important, where everyone nods their heads and agrees, to actually seeing successful implementation in 100% of surgical cases?

We don't have the answers, but we are trying.  We did some intense work in Congo last year with some positive immediate results and I'm looking forward to returning there soon to see how they are doing. Here in Madagascar we are working with the local hospital in re-writing the checklist (the WHO version is a guide, meant to be modified to fit each practice and hospital).  We have been doing a lot of simulations, getting them to try it out and get comfortable with it before trying to implement it under the stress of having a patient on the table.  It's going well, and hopefully in a few more months we will have a great success story to write!  This week I head out with a team to travel to other hospitals in Madagascar and try some different methods; more intensive teaching for a shorter time frame, etc.  

It's our hope that through this simple checklist that we could see transformation of surgical care in this country, and in the world.  It's exciting work to be a part of - thank you for your prayers and support!!

Me helping the local team go through simulation training.

Talking through the process in the OR


26 January 2015

“I've got a thing for genuine people.” – message on a crewmates’ door down the hall.

“Thank you for being real in this place.” –treasured words from a treasured friend.


gen•u•ine [jen-yoo-in] adj.

Possessing the claimed or attributed character, quality, or origin; not counterfeit; authentic; real.

Of all the words in the world, this is one I love more than most… especially when it is used by others in description of me.   In my life’s journey, there is no sweeter word; it is the cry of my heart, the longing of my soul, and I can think of no higher compliment. 

It hasn't always been this way.  Redemption is a beautiful thing. I am not who I once was; in various seasons long gone I would have been called anything but genuine.  Manipulative, controlling, secretive… those insidious words were once accurate descriptors of me.   I believed for so long there was just something inherently wrong with me, as a person, that I did everything I could to hide who I really was… begged God to change me into a different person, even tried to BE a different person. But God, in his infinite, compassionate grace, slowly and surely broke away those beliefs until I was, and am, left with the truth. Instead of changing me into a different person, God has been changing me into more of me, which in turn, is more of a reflection of Him. Genuine. Authentic. Real.  


I just wish we could be REAL about this!  I hear this phrase, or something like it, far too often.  Why is this even a thing? Why can’t we be real, be genuine, always?

My dear friend Erin wrote this, concerning being real as it relates to Christmas:

“It’s like we know the Hallmark version of Christmas is actually quite fragile, but we want it to exist and nobody wants to be the one to shatter it. So we smile and play along, then berate ourselves for not having a better time.

(read her blog here. You won’t regret it)

It resonated deeply with me at Christmas, but much beyond that, too.  

Simply replace Christmas and you get the idea…

It’s like we know the dream version of the ship community is fragile, and no one wants to be the one to shatter it. So we smile and play along, then berate ourselves for not having a better time.

It’s like we came to the ship expecting it to be one big blissfully happy family: always encouraging and welcoming and loving; all giving and receiving and never disagreeing about anything; a community of like-minded individuals who immediately become family and we all come together every night and hold hands and sing kumbayah; of course we’ll be surrounded by people who couldn't possibly ever be hurtful or selfish or angry or distant, because Jesus isn't any of those things.  And when that dream world doesn't turn out to be reality, we find ourselves curled up in our beds crying silent tears, gasping for breath, thinking to ourselves what is wrong with me? and wondering how is it possible I can be  surrounded with people and yet feel so desperately lonely?

But the ship doesn't have the copyright on this shattering of reality.

It’s like we know the fairy tale version of marriage is fragile, and no one wants to be the one to shatter it. So we smile and play along, then berate ourselves for not being a good enough wife.

It’s like we know the June Cleaver version of family life is fragile, and no one wants to be the one to shatter it. So we smile and play along, then berate ourselves for not being a good enough mother.

The possibilities are endless.


It’s easy to write about being real.   I read blogs like Jamie The Very Worst Missionary, or Sarah Bessey, or Rachel Held Evans, orParenting: Illustrated with Crappy Pictures, and I applaud them for being the voice of reason in this or that, for being real in a world afraid to shatter the image of missionaries or motherhood or marriage. 

But what I see each of them and all the others writing about, and hear from the mouths of my friends near and far, is that we all want to be real, we all cry out for others to be real… but when push comes to shove, when reality hits, when that new crewmember says hi or you walk through the doors of the sanctuary looking for a place to sit or you long for depth of conversation with someone… we aren't.  We’re inherently fine when we clearly are not; we smile and play along, talking about the weather or the news or other equally safe topics; we gloss over hardship with a platitude of a promised prayer that never materializes or a coffee cup verse that just makes everything all better because after all,  Jesus suffered a lot more than we are. So suck it up and smile and for goodness sake, don’t tarnish the image of (fill in the blank).


I don’t have a brilliant conclusion or a pretty bow to tie around and close out this post.  I don’t have the answers; I don’t know why we can’t be or aren't always genuine, real, authentic.  I think comparison has a lot to do with it, and comparison is the thief of joy.  I think being genuine looks a lot like begin fully alive, and the enemy of our souls will do anything to keep that from happening.  I know that I am not alone in this, and I think that all I can do is try to change this in myself and hope that it will spread; I will keep speaking life and truth and be genuine, shining light into darkness, and fighting for the hearts and souls and minds of the dear hearts I have the privilege and honor of walking with through this life and season.   

Transformation: HBB

25 January 2015

Yet another installment of the answer to the question “What do you DO, anyway?”

Well, first off, in my last post about BSSC I told you about the course but I didn’t actually write about what I personally did to pull it off – basically, everything except teach it!  Anything it takes to make that course happen is my job to sort out or get done.  Communication with the incoming instructors, writing the project plan, logistics, venue, catering, chair and table rental (if off the ship, as most are), finding participants, invitations, coordinate travel, photocopy materials, set up the venue, acquire all required materials… communication, communication, communication… then after the course I clean it all up, sort out any data collected, coordinate the follow-up and refresher days, write the project report, and make recommendations for the next course.

So this week, I had the privilege and honor of doing all those things, plus I got to TEACH the course!  Most of the courses we run are taught by outside instructors and the target audience is surgeons and other physicians, anesthetists, nurses, etc.  Fields in which I am not exactly qualified to teach.  So I’ve done my job well if the teachers can just come in and teach and don’t need to worry about any details.  But this week was different!

Helping Babies Breathe is a newborn resuscitation program created by the American Academy of Pediatrics for low resource environments and teaches basic skills and actions that can have a dramatic effect within the first few minutes of life.  Because I have so much experience in my previous life of being an instructor for the American Red Cross, and because I live in a hospital with a whole lot of clinical experts, I was able to step in as an instructor on this course – and it was so much fun!

Part of why it was so fun was the participants! They were Peace Corps volunteers that work in small health centers across Madagascar.  Back when I first got to this country I met with the Peace Corps director with the hope of collaboration, and this was the result.  The reason this was so near and dear to my heart was I was a Peace Corps volunteer (PCV) in Benin before joining Mercy Ships, and know how difficult it can be to feel like you aren’t really making a difference.  This course would offer them a tangible way to help see transformation in their villages.  We invited ten PCV’s to come to the ship and learn the action plan for the first few minutes of life – and then sent them out with all the teaching materials needed to train the birth attendants and healthcare workers in their rural health centers.  They were awesome students, caught on very quickly, and are quite excited to share their new-found skills.

Not only was teaching fun, having the PCV’s on the ship was awesome! I got to visit the ship in the middle of my service in Benin and got quite excited about things like dairy products and ice – things you don’t ever get in the bush! Well, these volunteers were no different. They got so excited about the ship shop, American junk food, coffee, ice, beds, warm water… and the welcome they received by this amazing ship family was second to none.

Overall it was an incredibly fun time that reminded me how much I love to teach, how much I love Peace Corps, how much I love this ship and the awesome work I get to be a part of…. And hopefully it will all lead to saving precious babies lives across Madagascar. 

Thirty Four

24 January 2015

This first week of life as a 34-year old has been crazy, insane, hard, fun... and altogether normal for ship life. :)

Sunday morning I opened up the cafĂ© as usual with the ever lovely Dianna, but this morning also included a few balloons, banners, and extra special sweets - food, and people!

I really love cinnamon rolls. Better than any birthday cake, that is for sure!! A whole tray? Perfect.  The best gifts in the world are even better when they are shared. :)

So these lovely treasures lingered over coffee and cinnamon rolls, along with some other treats made by other friends... sigh. Perfection - this is what I love about this community.

Then Natalie and I went to the beach. Not bad. :)

What is even better than cinnamon rolls? Treasured, holy words from treasured, holy friends. Best gift ever.

So that was day, low key and just right.  The rest of the week has blurred past, I got to teach a class (will write more in the next blog post), took care of a few crises (that seemed like a bigger deal than they really turned out to be), wrote a couple hundred emails and today I'm trying to catch up with writing, laundry, etc.  Such an exciting life. :)

Thank you, friends and family, for all the birthday wishes and love.  Here's to even more adventures in this new year and always... xxk

A Year in Review.

18 January 2015

January tends to be quite a reflective month for me; not only do we have the turning over of a new calendar year and all of the resolutions talk that it brings, it's also the anniversary of my arrival into the world, several weeks early (an event for which my friend Natalie last night said "hey, say thanks to your mom, too! so thanks mom, from Natalie...)

It's not a milestone birthday this year by any stretch, except that I am no longer "l'age du Christ" (the age of Jesus) which seems to be an important age here in Madagascar.  Last night I went out with some dear friends and didn't get the molten chocolate cake I wanted (power cuts! argh) but everything else was perfect; lovely friends, wine, laughter, stories, joy.

Another lovely friend said I had to go through my 'year in review" starting with December and naming the highlights of each month.  It was so fun to go through this last year and wow, when you put it like this - what an incredible year!!

December - A week away in the most beautiful place on earth.

November - a weekend adventure with friends.

October - watching my home come home.

September - "Surprise, you're going to Madagascar!" And being part of the first group to get to see Toamasina, the place we now call home.

August - Shenanigans in London, Windsor, Oxford... then Tenerife and Gran Canaria, Spain

July - Two weeks in Sweden with a treasured friend, seeing the town my ancestors came from... being so near the north pole it was light all night; and then just a few days later crossing the equator in Uganda!


June - French cheese, French wine, French beaches, French lessons, new friends....

May  - Flying in an ultralight plane!

April - Weekend adventures with friends.

March - A super busy time of blessing the people of Congo, including a trip to Brazzaville where I was referred to as Mr. Ships.

February - Being so blessed to be able to fly to Seattle for a few days with my heart family during a hard but exceptionally beautiful time.

January -  The crisp sunrise in my childhood home, time with family, rest and renewal.

Wow, when I go through it like that, I can't help but get teary. How on earth did I get to be so blessed? Never in a million years did I anticipate this would be the story of my life, of flights and languages and cultures and joys and an overwhelming abundance of love and favor.  Thank you, dear ones, for this year.  And I can't wait to see what this next one brings.


Mooring Lines

16 January 2015

Do you know what a mooring line is?

It's one of those giant ropes that keep ships, like the Africa Mercy, attached to the dock.

You can see them in this photo of the bow of the Africa Mercy.  They are like as big around as my leg and are very very heavy.

Today we snapped some mooring lines!  Can you imagine the power of the water that will cause a line like that to just snap, as if you were ripping a thread?

What could cause such waves?  A cyclone. Which is the Indian Ocean equivalent of a hurricane.  

Now, please don't get panicked.  They are out there but not currently a threat except probably some windy and rainy weather over the next few days. There are actually two - one just made landfall on the other side of this giant huge island (the 4th largest in the world) and the other is spinning harmlessly away from us out to the east.  And by harmlessly I mean it won't come this way, however, it's churning the water something fierce - thus, the snapped mooring lines.

I've never had my plans altered due to a hurricane before, so there's a first time for everything - I think my hike on Sunday will have to be cancelled!

Check out more here:

Transformation: BSSC

15 January 2015

A few weeks ago I wrote the first of several promised blog posts answering the question "What is it you DO, exactly?"  If you recall, my job is to bring transformation

The Basic Surgical Skills course is a two-day program designed to train surgeons and other physicians in the use of safe surgical techniques that are common to all forms of surgery and emergency care.  This course was developed by the Royal College of Surgeons in the UK and is required for all surgical students.   Much of the materials for the course are graciously provided by Johnson & Johnson and give the participants an opportunity to do something they rarely get to experience: they get to practice their skills.  

In all the courses we have run so far, we have used some kind of practice equipment; be it manikins for CPR or intubation, fake skin or foam for suturing, or infant simulators for newborn resuscitation; and the resounding request from all participants is can we do that again?? 

The Malagasy healthcare workers we are training don't have the luxury of skin simulator pads or extra suture for practicing; the only practice they get is on cadavers in medical school or live patients in their hospital.  That's where we get to be really generous!  We supply them with more than enough gloves, they don't have to wash them and reuse them again!  The course uses simulator kits and plenty of extra blades, sutures, and instruments so the participants are able to not only learn new skills but repeat them and practice them over, and over, and over, with expert supervision and guidance, until they get them right. 

But the practice opportunities don't stop at skin simulators; these doctors get the best training we can offer and for this course that means animal tissue. To be precise, pigs intestines (to practice bowel repair techniques), aorta (blood vessel repair), belly (for practicing different kinds of stitches, and removing of cysts and other lumps and bumps) and feet (tendon repair and wound cleaning).  These tissues most closely resemble their human counterparts and provide the most ideal training setup. 

I, as course manager, and my team, learned some valuable lessons this year during BSSC. Most notably, even if it is refrigerated, fresh pigs tissues degrade rather quickly and permeate the air with a most unsavory odor.  We used a LOT of air freshener.  

But nasty odors aside, the participants were all so pleased with the course and asked over and over, "when can we do this again" and "can we have this refresher training every six months?".  These surgeons and doctors learned valuable and critically needed skills for surgery, and one can only hope and pray that those new-found skills (or newly refined skills) will positively impact the lives of hundreds of future patients. 

Transformed people = Transformed medical practice = Transformed national health structure. 

Not a waste of materials, an abundance of blessings for the physicians and their future patients! 

Under that neoprene foam (which simulates the abdominal wall) there is a balloon!  The job of the surgeon is to open the cavity and then repair it without popping the balloon! 

Yep, those are pigs feet.

Shining light.

11 January 2015

There is a big fat disgusting lie that I want to blast through right now, as I am continually seeking to shine light into darkness.  I’ve heard it at least half a dozen times in the last few weeks from various friends and colleagues and coworkers.  And I see it in myself, too. And quite honestly? I am sick of it.

It’s the lie that everyone else knows exactly what they are doing, except me.

It sounds like… I just wish I knew what I was doing or I’m gonna mess it up or what on earth were they thinking putting me in this role?

So you feel like you don’t know what you are doing? 

Here’s the truth.

No one does.

We are all trying to figure it out.

Even those who seem like they have it all together.

Because guess what? No one has ever done this before.  This thing we are trying to do, in this country, with these people and this leadership team and these coworkers and personalities and cultures and stories involved, at this time with these resources. No one.

None of the nurses have ever faced this problem (whatever it is), in this patient, with this health history from this country, with this team and leadership and resources available to them.

None of the managers have ever managed this particular team, with its individual characteristics and personalities and ages and cultures, in this environment, with these resources and challenges and languages. 

Even our senior leaders, while confident and strong and decisive for sure, have never done this particular thing in this place at this point in time, either.

We are all trying to figure it out.

We are all trying to do the best job we can.

We are all trying to put one foot in front of the other, to say the right thing in the right moment, to bring God the most glory we can. 

We won’t always get it right.  We can offer grace to each other. We can help each other and walk alongside each other and know that we aren't alone. (As Kid President says, "I have barbecue sauce on my shirt, too.")

But believing the lie that everyone else has it figured out except me is not healthy. It isn’t true. 

So for cryin’ out loud, take a deep breath, and give yourself the freedom to not have the right answer or the perfect plan or the next steps outlined in the landscape that is in front of you.

We’re all in this together. Figuring it out as we go along. Offering grace when it’s a toss-up between several options and we just picked the wrong one.  Celebrating when we happen to have picked the right one.  We learn, we grow, we get to be a part of lives changed and transformed and we leave here looking just a bit more like Jesus than when we came. God has promised that we can do all things and we are more than conquerors and we are chosen for this purpose, at this time, in this place. 

Rest in that. Trust.  He’s still on the throne and not saying geez, I wish I had put someone else in that role.

Don’t know what you are doing? Neither do I. Neither do the rest of them.  It’s a new day with new challenges and the beautiful thing is that we get to be the ones who figure it out.  Of all the people in the world to face this brand new situation with these people and resources in this place, he picked YOU.  Sweet.

Go on, world changer. Keep on shining light.


10 January 2015

I’ve been sitting on this blog post for a week; ten days, actually, since the first words appeared on my screen and the big ball dropped in New York and I went to bed long before midnight.  I feel like I should write a big fat HAPPY NEW YEAR and a subsequent post about how great it is going to be and how happy the world is and I am and I wish sunshine and confetti and big chocolate teddy bears to everyone.
But what I want to experience this year? Not happiness… It’s joy I want, it’s joy I am looking for and fighting for and longing for this new year.   There is a depth to joy that cannot be touched with happy… happiness is actually a cheap imitation of joy and it is fleeting.  One phone call, one wrong look, one email and happiness is gone – but joy, to the depths, that cannot be shaken? Regardless of circumstance?  That’s what I want.
In 2014 I visited several new countries, rose to the challenge of my new job, made new friends and deepened friendships with others, tasted my first Crunchie bar (how do we not have these in America??) and spent the last day of the year on a tropical island paradise. I also watched helplessly as Ebola ravaged the people and the places I love in West Africa, I said ‘see you in eternity’ to a few dear friends, and battled insecurities and loneliness more than I ever have before.  The constant through all of this? it certainly wasn’t happiness.  There isn’t a whole lot of happy in the room when you are grieving deeply.  But there is a deep and resounding joy, unshakable, rooted in the knowledge that this is not all there is, and somehow, though I don’t understand it, all of it is for my good.
My Christmas was good and my New Years was enjoyable, but I cried more this year than I ever have and even this last week has been… shall we say… emotionally challenging.  Really? There isn’t a whole lot of happy in me at the moment. But there is joy in knowing I am called here to this season and I will continue to fight for freedom and new depths of joy, regardless of circumstance. 
I don’t make new years resolutions as I think often times it’s just another opening for the darkness to whisper you have failed.  I do, however, think we should always be evaluating and re-evaluating our goals, or hopes, our dreams, the cry of our hearts.  Mine this year?... or rather, not just this year but always? Be brave. Speak life.  Bring light to the darkness, love and be loved, chase freedom regardless of what stands in the way.  Choose and fight for joy, in all circumstances.
May your 2015 be joy-filled and life-giving.  Much love to all – Krissy
Palm tree selfie with two dear friends

I used my underwater camera for the first time underwater!

Sunrise on 04 Jan, 2015  Ile aux Nattes
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