Africa Mercy- Hospital Ship

Written March 14^th, 2012

With just under a week left onboard the Africa Mercy and a member of the Mercy Ship community here in West Africa, I felt like another blog entry was in order.

Mercy Ships is an international Christian charity using hospital ships partnered with land-based programs to deliver transformational health care at no charge.  Mercy Ships has provided services in developing nations since 1978, and the Africa Mercy remains the world’s largest non-governmental, non-profitable hospital ship dedicated to the continent of Africa.  While providing surgical and primary health care, relief aid, and community support, the Mercy Ships team is dedicated to bringing physical and spiritual hope and healing to the people of Africa. 

Over the last several weeks I have seen this in action…. physical change and transformation……and spirits lifted and set free!  The hospital onboard deck 3 of the ship consists of 6 operating rooms (4 in use at the moment- ophthalmology, general, plastics and max-fax), a recovery room (PACU), three wards (A, B, and D), lab/phlebotomy department, equipment sterilization department, pharmacy, and radiology department (with an x-ray and CT scan).  In fact the CT scanner is the one and only in all of West Africa! The three wards are divided by specialty:  A= General Surgery; B= Plastic Surgery; and D= Maxillo-Facial Surgery (also known as Max Fax). 

NOTE: Refer to my Screening Day Blog

This is little Sibi who had a bilateral cleft

lip repair.  She is absolutely perfect! 

The majority of my shifts have been on A-ward which has been nicknamed “hernia land”.  Aside from hernias we have also see many thyroidectomies (partial/complete) in goiter patients with enlarged thyroid glands.  The first couple weeks of surgeries we only had a max-fax surgeon (maxilla-facial) so I had the opportunity to care for those patients as well.  Now talk about transformation……it is absolutely unreal what these surgeons can do!!  It is nothing I have seen before, nor anything we would ever see at home.  For example, some of these facial tumors have been growing for decades, growing to the point where life is at risk due to airway compromise.  For many, the daily physical struggles (i.e. loss of vision, difficulty eating, difficulty breathing, etc.) do not even compare to the ridicule experienced and the solitude they succumb to.  These individuals truly live their life hiding!  And yet, their faith in God and the trust they have in us as a multicultural, multigenerational, and multidisciplinary health care team is undeniable!! 

In the last couple weeks we have also had several plastic surgery patients admitted to A-ward as B-ward fills to capacity. Aside from those patients, I have also been fortunate to float to B-ward for a few shifts which were a nice change.  Oh and might I add that plastics has a lot of pediatric patients!! YAH! The majority of our plastics patients onboard are burn victims who have acquired contractures which ultimately limits their mobility.  These include contractures over a joint (affecting axilla, knee, elbow, hands, feet or fingers) where the scar prevents or reduces movement.  These patients are admitted for an extensive period of time to address wound care needs (of both graft and donor site) and to ensure proper nutrition for healthy wound healing (vitamins and dietary supplements).  What can I say….these people are fighters!!

                                                                                                                                                                                                         

Consistent with what I had been told by those familiar with Mercy Ships, the nurses here are worked pretty hard!! I guess that is something universal!  Day and evening shifts are 8 hours long and night shifts are 10 hours.  This has been a nice change from home but it’s not uncommon to work 4-5 shifts in a row with a day or two off and then right back at it.  When I find myself getting tired and warn out….I just remind myself that that’s why we are all here…..for the patients….for the people of Africa!  There is something special about being among people who have come together to work for a common good.  Despite the numerous differences (cultural, background, age, gender, language, etc.) that evidently exist between the hospital crew…..we all have one thing in common….we have all dedicated time and heart to the work of Mercy Ship!

        

         

A typical day shift might look like this:

·        Prayer- nurses and day workers/translators

·        Patient handover/report

·        Nursing care- administers meds; dressing changes; assessments; procedures;    patient/caregiver teaching; prepare patients for surgery, etc.

·        Deck 7- after report between day and evening nurses, patients get the opportunity to go outside for some fresh air!  The Patient Life Team brings games, music, song, dance, etc.

The wards have a happy, healing, supportive and therapeutic atmosphere with the possibility (a good possibility) of song and dance occurring at any moment!

A few other things my fellow nurses might appreciate:

• There are no permanent curtains between each bed.  If someone needs a private moment (i.e. for a dressing change, to use the bed pan, etc.) there are curtains that are temporarily hung around the bed.  No such thing as private room unless patients are isolated/on precautions (i.e. infectious).
• Each ward is divided into 2 rooms with 10 beds on each side- 4 rows of 5 beds with a capacity for 20 patients.  ICU 5 beds (2 isolated).  There are 2 bathrooms per ward and one nursing station.  Therefore as you can imagine we have learnt to work in close quarters.  It has been cozy!
• Adults and pediatric patients are randomly dispersed around the ward. Can you imagine this at home?? Somehow is just works here! If you didn’t know any different you would think these people had been friends for years.  If a baby is upset it only takes a moment for a momma (could be any momma) to scoop them up and tie them on their back. 
• Patient care givers (must have a caregiver if younger than 16 years old) sleep under the patient’s bed on a cot.  We have family centered care here too!
• Med cups are washed and reused!  It sure makes you realize how much we waste at home.  I’m sure infection control would have a hay day if we were to propose this.    

Other Mercy Ship projects off the ship include:

HOPE Centre (Hospital Out Patient Extension)- was built to improve health care delivery by providing 40 beds for patients awaiting surgery or requiring outpatient care post-operatively (i.e. for those that live up country/far north).  They also provide 40 beds for a caregiver that accompanies the patient (a bed under a bed that is!).  The centre was built as an attached to the government clinic of Be-Kpota Anfame in Lome.  It not only plays a pivotal role in the recovery process, but also services to expand the clinic’s capacity to serve patients after the departure of the Africa Mercy when it’s donated to and used by the clinic. 

Dental Clinic- The dental clinic is held on the second floor of a government building in Lome which has been designated for their use.  The clinic has 9 chairs, with the capacity of accommodating 4 dentists (2 chairs per dentist) and 1 dental hygienist. Mondays and Thursdays are screening days where people receive appointments based on need for the rest of the week (NOT first come first serve). Those people needing care immediately are pulled from the line and treated that day.  From January-June of 2012,  the Dental team will serve approximately 4,000 people, averaging between 45-50 per day (about 11,000 procedures over 6 months) affected by tooth decay, infections, and small oral lesions; provide clinical dental hygiene services to 450 people; provide up to 340 dentures to patients requiring replacements; facilitate basic oral health education to 4000 elementary and secondary students and 4, 000 clients in the dental clinics (with teaching taking place in the waiting area); and mentor 4 dental health mentorship participants in various aspects of assisting, sterilizing, and teaching oral hygiene.  The dental team aims to reduce the incidence of dental disease by providing dental education and treatments such as restorations, extractions and cleaning. 

Eye Centre (Mercy Vision)- The eye team works towards reducing the prevalence of blindness and low vision due to cataracts, pterygium, and other eye problems, while building the capacity of eye care systems in western Africa.  From February-May 2012, the eye team hopes to perform approximately 450-500 specialized surgeries to correct blindness due to cataracts; perform 65-75 specialized surgeries to correct blindness due to pterygium; increase awareness about basic eye health issues; reduce the impact of harmful UV radiation and the related incidence of eye disease by distributing 2,000 pairs of UV-blocking sunglasses; and improve the functional eyesight by distributing 2,000 pairs of reading glasses.

Mercy Ministry involvement in Lome:  (I attended each one once)  

• Bethany Orphanage in Lome- groups visit and play with the kids every Saturday (ie. Games, read stories, crafts, paint nails, etc.)
• Juvenile Detention Centre- groups visit every Thursday to spend time with youth. The group leader delivers a message (for example the week I went the top was forgiveness) to start dialogue and sharing among the group. Typically the session is ended off with a game.  It is no surprise that these kids/teens thrive on this time once you see the small, primitive cells that they spend the majority of their time in.  Many of these youth have done petty crime and are simply waiting for their case to be reviewed by the court.
• City Hospital- Pediatric Ward- groups visit the pediatric orthopedic ward once a week at a large hospital in Lome.  Most of the patients are bed ridden (i.e. in traction….. although the weights were often resting on the ground) so we had to be creative.  Coloring, reading stories, bubbles and balloons were a big hit!
• Special Needs School- once a week a group goes to a special needs school in Lome.  This was so much fun!  The kids (all grades) gathered in one room for a story, craft, games and dancing!! Let me tell you….African’s can dance!  There was a wide spectrum in function among these kids from behavioral issues, autism, Down Syndrome, and CP to name a few. These kids were amazing!

Okay, I feel like I might be losing some of you so I’ll wrap it up!  To conclude…..

CALLING ALL NURSES!! There are several vacant nursing positions from the middle of April to the end of the Togo field service in June.  If you are interested let me tempt you with the idea and perhaps give you the little nudge or firm push you need to REALLY consider it!  It has truly been a positive experience….both personally and professionally!  Let me know if you want more info.   

QUOTE:

‘May today there be peace within. May you trust that you are exactly where you are meant to be. May you not forget the infinite possibilities that are born of faith in yourself and others.  May you use the gifts that you have received, and pass on the love that has been given to you. May you be content with yourself just the way you are.  Let this knowledge settle into your bones, and allow your soul the freedom to since, dance, praise and love.  It is there for each and every one of us.’

SCREENING DAY!

February 1^st, 2012 was a life changing day for many West Africans, both Togolese and those travelling from beyond its borders.  It was a long anticipated day for everyone involved with months of strategic planning, preparation and coordination.  I am more than pleased to report that things went smoothly from start to finish and the level of teamwork was overwhelming to say the least. It will certainly be a day none of us will forget! I am sure of that!!

 Between 3500-4000 Africans lined up along side the walls of Kegue Stadium in Lome, Togo, where approximately 300 Mercy Ships volunteer crew conducted a medical screening….and ultimately a chance for healing.  Some had arrived the night before to claim a spot in line in hopes of receiving a yellow card and ultimately a surgical date.  Pre-pre screening began the evening before where medical personnel spend hours deciding whether individuals met our surgical criteria to continue in the screening process.  The main surgical specialties this field service includes maxillo facial surgery, plastic surgery (i.e.  burn contracture releases), general surgery (i.e. Hydroceles and Hernias), and VVF repairs (Vesicovaginal Fistula Repair).

Starting at 0430 the first convoy of eleven Land Rovers left the port on route for Kegue Stadium.  This meant for an early wake up at 0330 to fit in breakfast and go.  As we approached the stadium grounds, I sat in silence at the sight of thousands of people patiently waiting in line. Through the darkness you could see their vibrant colored clothing and eager demeanor. After pre-pre screening over 200 people, approximately 100 spent the entire night waiting in line, while hundreds more started to gather between 0300-0330.  The night crew had a challenging job of weaning those not suitable for surgery with the mere light of a head lamp.  Once we arrived just after 0500 the Land Rovers headed back to the ship to pick up the next group.  As part of the history-taking group (12-14 nurses), we set up our stations and got orientated to the area. 

As people progressed through the various screening stations, 1609 people entered the first gate and were pre-screened.  Gates closed between noon and 1 pm with 574 people proceeding from pre-screening to registration, and onto history-taking.  Here our role was to take patient’s vital signs and ask a set up various health related questions.  Each nurse was paired up with a translator who could speak English, French and Ewe.  These men and women are West African people who have been hired by Mercy Ships as day workers (on & off ship). Let me just say that these are absolutely incredible people and we would honestly not be able to do our jobs as nurses/medical personnel without them!!  I will admit that I was a bit nervous and perhaps somewhat skeptical in how effective one can communicate through a translator.  Consistent with the saying, “lost in translation”.  With that said, my translator on Screening Day was amazing and his approach/ presence with people whether young or old, male or female was inspiring.  He reminded me of the power of communication, language and culture…..and to have a little more faith in what is meant to be!

After completing the patient history, patients were escorted to the designated specialty area (general, plastics or facial) to be seen by a physician for a more comprehensive assessment.  From there some got blood work done by phlebotomy while some others had needle biopsies done by a crew pathologist to determine whether tumors were benign or malignant.  After data was collected and entered into the computer system, 475 people had been scheduled for surgery, x-rays, CT scans and/or further lab tests.  Those people received an unfathomable opportunity for further medical investigation onboard the Africa Mercy free of charge.  That day they walked away with a yellow card….and more importantly a ticket for potential change and healing!

Note:  Those 475 people are among many others who had already been assigned surgical slots prior to screening day.  For example a large portion of the general surgery and VVF surgery slots had already been accounted for.

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As I mentioned before, SCREENING DAY was without a doubt a team effort!  The flow of the day went so well and I truly believe we can contribute that to the various roles people dedicated themselves to.  Roles included distributing food and water to patients, families and crew members; patient escorts (crew escorted patients from one area to the next so they were never alone in the process); child ministries (entertained the children); security (crew members, day workers and Gendarmerie); pre-pre screening; pre-screening; registration; history taking; physical assessments; phlebotomy; data collection; appointment scheduling; and more. 

I feel like it is also important to acknowledge all those we were unable to help that day.  For example: those requiring orthopedic surgery (don’t have an orthopedic surgeon at this time), those with malignant tumors, etc.  In hopes of offering healing and grace to those people, a prayer station with members of the Patient Life Team was set up under a large tree.  The Patient Life Team is a team of African day workers who work with patients in various ways to support their emotional/spiritual/intellectual and social needs.  They are our ‘go-to’ people and such an asset onboard!

Note:  When possible other resources were referred to patients such as Dental Clinics and Eye Clinics that take place off ship.

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Okay!….to wrap things up….I want to end with saying that I am so proud and blessed to have been apart of such a fundamental day and the beginning of Mercy Ships Field Service Togo, West Africa, 2012!!! It was an absolute surreal experience….truly beyond words.  I think everyone would agree that pictures speak louder than words so I share these in hopes that it will paint a story for you.

 

 

(NOTE:  All pictures taken and edited by crew photographer)

In the days following Screening Day, someone onboard challenged us to think about how Jesus often works backwards in wonderful ways as seen that day at Kegue Stadium.  The poor were rich that day, those normally seen last were seen first and those who are normally ridiculed and avoided were praised and touched!!!!

Here is a link for a short video that our videographer created from SCREENING DAY….FEBRURARY 1^st, 2012!

http://youtu.be/UwrBKTbhaCc

That's it for now!