Monday, 8 October 2012

Hospital Hierachy....the poorest of the poor

I have been thinking a lot about training and education.  As a hospital ship we aim to provide surgical health care to the host countries we visit, but we also try and provide education and training for doctors and nurses. However, this is not as easy as it sounds, it is an area we are developing, and it has got me thinking.
Mercy Ships has been in Guinea for 6 weeks. In that time we have set up our hospital and have received over 50 different requests for training, from various sources. We are managing these according to (i) what falls within our areas of expertise; (ii) assessment against predetermined criteria;  (iii) and finally, because of our own limited resources, what we consider a priority.
Interesting that last point…..what we consider a priority……what do you think? Who would you prioritise for training in a surgical hospital?
         i.            Surgeons
       ii.            Anesthetists (doctors or nurses)
      iii.            Nurses
     iv.            Lab technicians for diagnosing with blood tests
       v.            Xray /ultrasound technicians / radiologists for diagnosing using imaging
     vi.            Sterile Processing technicians who clean the surgical instruments
Until last week, I think I would have focussed on the doctors and nurses? Maybe that’s because I am a doctor? But I met someone a few weeks ago who has changed my focus.
Christina is a Canadian who works in Sterile Processing. She is also an instructor for the International Standard qualification. But more than this, she has an incredible passion to help West African hospitals improve their hygiene standards and to take ‘sterility’ seriously. Spending time with her has been enlightening.
I drove Christina to the 3 main hospitals in Conakry, the capital of Guinea. One hospital did not even have soap and water to wash your hands with. Another used laundry detergent to clean the surgical instruments after an operation. There were no brushes to clean the instruments, so they cleaned them with rags or bare hands. There was no disinfectant, let alone any functioning sterilisation equipment of any sort. Dirty instruments were kept close to the ‘clean’ ones, the walls and floors were filthy and there was clutter everywhere. Many of the surgical instruments were rusty. Totally the opposite of what would be described as ‘best practice’. Christina, spent time with the workers and then spent 2 weeks literally ‘rolling her sleeves up’. She helped clean the floors and walls, gave the workers gloves and brushes to clean with, and educated them in simple practices to improve the hospital hygiene.
What amazes me is that the people who act as sterile processing technicians in Guinea, have no training; they are given no gloves to wear even for handling hot steamers so many have burns; and furthermore they are not even paid! They hang around all day, hoping an operation may happen (only if the patient can afford to by the necessary supplies such as drugs, cannula’s and fluid) and then hoping that the surgeon will ask them to clean his instruments afterwards. Then the workers wait to the end of the week and hope the surgeon will give them some money for their efforts, but the surgeon is not obligated to do so. They literally wait around for work, and then have to depend on the goodwill of the surgeon in order to feed their family.
Mercy Ships aims to help the poorest of the poor, by working in West Africa. It struck me that Christina, is also working with the poorest of the poor amoungst the hospital hierarchy. Sterile Processing technicians tend to be the forgotten ones, even in hospitals in England.
My time with Christina has made me think. I can train a surgeon or an anaesthetist, but if the instruments are still dirty how much will it ultimately achieve? As a medical student many years ago in Zimbabwe, I vividly remember a missionary surgeon taking me to a lady whose hip fracture he had expertly fixed. But now she lay dying of sepsis, from bed sores due to poor nursing care, and also no doubt inadequate sterile practice. A doctor can be expertly trained but without the support of his team, he will never reach his full potential.
Training doctors in Africa sounds glamorous, training Sterilisers doesn’t.  But I am not interested in glamour. Neither was Jesus. He rolled up his sleeves, got down on his hands and knees and washed his disciple’s feet. Reminds me of Christina, cleaning the operating rooms in Guinea on her hands and knees. Giving value to a profession that is undervalued. Making a difference.  From now on sterile processing will be part of our medical training initiatives in West Africa because it seems to me, that the poorest of the poor in the hospital heirachy, have been forgotten for far too long.
Thank you Christina for what you taught me these last few weeks & good luck with setting up your charity / NGO: Sterile Processing Education in Developing Countries……or whatever name you decide upon. May God bless your endeavours and make all you do succeed.


  1. Hi Mich - you write so well. I feel inspired in wet Bristol to re-evaluate my priorities! God bless you, Becca

  2. In a competitive field such as that of surgical technicians and technologists, job opportunities will always be best for one who is certified and are willing to relocate the only themselves but their family and the pursuit of job opportunities. Click here

  3. Hi Mich,
    I am reminded that before trained nurses came along, surgeons often operated on kitchen tables
    In the 1860's Florence Nightingale reduced the non injury mortality rate from 60% to 6% through good hygene, good nutrition and very basic nursing care (in Scutari)
    food for thought
    Thinking on the plight of the hospital technicians; Provide training for them in all aspects of managing a surgical service, unite them by creating a college or guild or collective (guild sounds good because the circumstances sound pretty medieval).
    as a collective they will be capable of potentating the surgeons skill and enhancing the local outcomes - thats the theory anyway!