Contrasts

I have just spent two weeks in the Democratic Republic of Congo (DRC), which is the poorest country on earth, according to the United Nations Health Development Index (UN HDI). I was visiting the capital city Kinshasa and the port city of Matadi as part of a Mercy Ships Assessment Team. We were invited by the Ministry of Health to (i) build relationships with them as they have invited Mercy Ships to work in their country (ii) assess how the surgical services and healthcare education Mercy Ships offers can help their nation; (iii) assess the logistics of transporting in excess of 1000 crew backwards and forwards from Kinshasa to Matadi approximately 500 km away; (iv) assess feasibility of having 400 crew in Matadi with respect to food, water, leisure acivities etc. What struck me most was that Kinshasa was a city of contrasts and the DRC is a stunningly beautiful country. I admit to being a little scared beforehand. The DRC was afterall the poorest country on eart and I fully expected to be shocked at what I might find. I imagined a mixture of Freetown, Sierra Leone (people everywhere so it is hard to even walk in a straight line in the street) and Monrovia, Liberia they had not had running water of electricity for years making it impossible to deliver quality healthcare. Kinshasa was a sprawling city but despite 10 million people it was not as busy as Freetown, and the infrastructure was better than Monrovia. However, poverty was evident with some hospitals struggling for electricity, and equipment. As is common in other hospitals in west and central Africa the operating rooms are stark and bare…..and could be what you imagine a torture chamber to look like. But two hospitals in Kinshasa were some of the nicest I have seen in Africa. I was truly impressed, by renal dialysis units; neonatal intensive care units; CT scanners, MRI and mammography; fully equipped laboratories with PCR the only major diagnostic technique that was lacking; and fully equipped operating rooms and sterilising machines that seemed to work correctly and at the correct temperature. What a contrast between neighbouring government hospitals in the same city. Loic, one of our translators had grown up in the DRC as his parents were missionaries there and still are. His insight and understanding of the culture was immensely helpful in deconstructing the prejudices and fears I had arrived with. Rebels, rape, massacres. That is what we read in the news about DRC. A country ravaged by internal conflict, unstable, unsafe and corrupt. Foreigners advised not to travel here. TRUE, but all the trouble is far away in the east, near the borders of Rwanda, Burundi and Uganda. This is almost as far from Kinshasa as New York is from Texas. Yes, we did see evidence of corruption, and yes we had the inevitable border hassle as we crossed the Congo river from Brazzaville, Republic of Congo into Kinshasa, DRC and back again. But all the people we met in the hospitals, the port, guest houses, local workers such as taxi drivers and shop keepers, everyone was helpful and polite. A country of conflict but also one of kindness and hospitality. A country of contrasts. Matadi is in Bas Congo province. I was impressed by the beauty of the region and the kindness of the people. Rich green fertile hills and countryside. Towns of subsistent farmers, selling produce all along the road from Matadi to Kinshasa. Apparently the 3 countries, DRC, Zambia and Zimbabwe have the potential to feed the whole African continent. Having been to all three countries I can believe this. And there is a new hydroelectric dam near Matadi with huge potential for providing the region with electricity. The port in Matadi is having some renovations and will be ready for us by January 2015. So I am praying that our International Management Team decide to come here soon so we can have the privilege of walking alongside the people of the DRC and sowing seeds of hope and help them realise their amazing potential. The DRC, a country of contrasts. Jesus, a man of contrasts. Born into poverty in a stable yet he was a King. Eternal yet temporal. Life in heaven versus life on earth. And as I ponder these contrasts, I am also reminded of my own life. Poor yet rich. Earning no salary but witnessing the generosity of others who provide for all my needs. Sharing a cabin instead of living in my own house. Giving up everything but somehow gaining everything. The DRC is the poorest country on earth yet with great potential. And this Christmas, no matter what contrasts you see around you, may you know the potential and the hope that is in and around you too.

Hope for Africa

Many young people in Africa want to leave and live in other countries to make 'better life for themselves'. Why? Because they believe Africa has no hope. They feel there is not enough food, not enough water, that Africa is over populated, and there is no hope for them if they remain here. Yet, this belief, is built on ignorance and lies.

In truth, Africa is least populated continent; Zimbabwe, Zambia and DRC have the potential to feed whole of Africa, there are great rivers in Africa for water and Africa has 40% of the world's hydro electric power potential. Every single African nation has mineral wealth and many coastal nations also have oil wealth. Africa is a beautiful rich and abundant continent. Yet many people (African or not) do not know this.

I learnt some of these facts from Chris Ampadu. We have just finished running a Medical Leadership course in Pointe Noire, where Chris and I shared the speaking. Chris is from Ghana and has run leaderships conferences for Mercy Ships for 7 years training government, community and church leaders. He works for Samaritan Strategy.

How can Africa, which is the richest continent in terms of natural resources, be also the poorest continent?

Because many people in Africa do not believe the truth. Many have a mindset of hopelessness. A worldview that is actually built on ignorance and lies, thinking Africa is cursed, but in fact, Africa is blessed. Blessed with abundant natural wealth and resources.

Apparently between 1980-1988 sub-Saharan Africa received $83 billion, and yet loving standards declined by 1.2% a year and the GDP (in per capita terms) declined 2% in 1986 and 2.2% in 1988. From 1990-2003 the region averaged $20.4 billion per year in foreign aid, yet the GDP was lower in 2002 than 1980. Africa has attracted more aid per capita than any other region, and yet it remains poor. Africa has rightly rejected colonialism, yet has not yet moved into embracing her independence. Instead, she continues to rely on western aid.  Needing external money for development instead of using her own resources. Chris encouraged Africans not to see themselves as beggars. But as people with dignity and resources. To move away from the 'poverty mindset'.

Chris asked another question, When major life events happen such as death to young people, how do people in your culture explain these things?

For many African's the answer is 'Witches'. When bad things happen the first question people ask is 'who did this to you?'  

What are the consequences of this? Eg when you as a doctor make a mistake, what will people think, how will they interpret it? 'It is not your fault, it was a witch / curse'. So if people don't hold you responsible where is the motivation to improve? Doctors don't worry they will be taken to court. Witches are blamed instead, which could be rather convenient.

Beliefs ....lead to.......values......which lead to.....behaviours.....and then.......consequences

We also discussed cultural attitudes to time, women, corruption, reliance on external aid and 'the white man'. Lies such as 'corruption is normal', and it doesn't matter if you are late for work. This is why there is poverty. This is why life feels hopeless. Yet only the people themselves and their leaders can change these things.

In discussion groups the medical leaders discussed cultural lies in the domain of medicine and what impact these had. Changing these mindsets is difficult. But if we are serious about improving quality of care and patient safety doctors need the humility to admit their mistakes and short-comings, and courage to initiate change. We know on medicine that Quality Improvement is a combination of leadership and process, not just better training  and technology. But for medical leaders here to feel empowered to lead well and initiate good processes in their hospital their need to understand their own worldview and the pervaded worldview of those they work with. Otherwise they will not be able to initiate lasting change.

The conference consisted of three days. The first day was all about exposing cultural lies. The second day, the 'soft' side of medical leadership, the 'heart' side of the head, heart, hands voice concept, otherwise known as the 4 'T's of leadership: truth, trust, teamwork and training. Chris brought the African side and I brought the western medical perspective. On the final day we spent a lot of time talking about one of my favourite topics, the World Health Organisation Safe Surgical Checklist. This is an example of good process which requires leadership, communication and teamwork to successfully and sustainably be implemented in Africa. No country in Africa has managed this yet. Perhaps the Republic of Congo could be first. They certainly have the potential to be. Only time will tell. I pray that these few days have sown some seeds. I leave you with an African proverb I learnt this week

'You can count the seeds in a mango, but you can't count the mangos in a seed'

It was a pleasure to work with Chris Ampadu and the rest of the team, Krissy, Stella and Francis. Thanks for all your hard work.

Perspective

When you sail into Pointe Noire, Republic of Congo, you sail past many many oil platforms. And as you get closer to the shore you see many ships, specially designed for helicopters to land on, with helipads mounted over the bow. These ships help get workers on and off the oil platforms. Once inside the the protected walls of the port, the 'oil' presence gives way to the usual vast array of container ships. This is a very busy port, so ship after ship is lined up, and on shore, huge areas containing hundreds or thousands of twenty foot containers are clearly visible. These container ships along with a multitude of tug boats and pilot boats form the view out of my window, or should I says windows. Yes, I am lucky to have a cabin with more than one window. At least I do temporarily, because I am cabin sitting for a family who are away so I get to see this busy port scene every morning I wake up. But I used to live in a windowless 6x5 foot space for over a year. Then I was upgraded to a space with a few extra feet and a small window that overlooked the admissions tent on the dock in front of a large concrete wall. Three, over thirty somethings, sharing a cabin (smaller than the bedroom I used to have all to myself back home in England). However, now I have a family cabin on the other side of the ship, so instead of the dock I get to watch container ships being loaded and unloaded, tug boats gently nudging lager vessels in the right direction, fishing boats bringing in their catches. All the comings and goings of a busy port can be viewed from the spacious couch in my new living quarters. It is amazing how it has changed my perspective. If all I had seen was the sail into port, I would have described this place in 'oil' terms. From the other side of the ship I saw patients come and go and I had a hospital perspective. My current cabin gives a proper port perspective. My windowless cabin-space gave no perspective at all, it was dark and I needed artificial light to do anything at all. It felt like I could have been anywhere in the world.......except that not many people, even in prison, live in a windowless cell. But that is another other story and windowless cells are not my point! My point is perspective. Perspective is just that. Perspective. It is not reality. Perspective may affect how we feel about reality but it does not define reality. Whether I can see the oil rigs or not, whether I see the container ships or not, whether I see the patients coming and going from the admissions tent or not, none of that changes the fact that they are there and part of my reality. Even the gloom and dark of the windowless cabin does not negate the reality, even if it feels suffocating and overwhelming. We need to fight for the right perspective. Why? Because it helps us deal better with reality. Recently I have read a few people's blogs, witnessed a few incidents and had a couple of conversations with people. Some of them are struggling. Life is hard sometimes. That is why we need the right perspective. When we feel like we are suffocating in a windowless, dark place, we need to fight for the correct perspective. The biblical perspective which is reality. The reality that God called us here, and He is for us. He loves us and has promised never to leave us or forsake us. He calls us 'overcomers'. It is the enemy who tries to make us think from the perspective that it is all too tough, that maybe we misheard God, maybe we aren't really cut out for this life. Rejection, loneliness, insignificance, fear ......all such thoughts can come pressing in and alter our perspective. And when we are too tired to fight, or too crushed, we need our friends to fight for us and encourage us to get our perspective right. Reality is truth. Right perspective is also truth. But the wrong perspective, or a distorted perspective, or merely only half the perspective....none of these are entirely true. And if they are not truth then they are deception. Lies. I love my new cabin, the new perspective and the feeling of space. In the same way, I love the biblical perspective. The biblical perspective on life gives me hope because it gives me the truth. And the truth gives me power to overcome the lies, deceptions and half-truths that creep around and get me down. My cabin perspective is only temporary, thankfully true biblical perspective is eternal.

Intersection

Last month I celebrated my birthday. That night the Africa Mercy sailed across the Equator at the point where it intersects the Prime Meridian. Point 00.

In the maritime world, sailing across this intersection makes you a “Royal Diamond Shellback.” If you simply cross the equator you are a ‘Shellback’ and if you cross the equator where it intersects the International Date Line you are an ‘Emerald Shellback’.

A few weeks ago on August 28^th, we undertook our biggest patient selection in the history of Mercy Ships. Selection day is a day mixed with intersections of a different kind. Hope and disappointment. 7,354 people queued up, and 4,236 made it through the gate. That means 3,118 were turned away by the crew who walked the line. That’s a lot of hopes dashed. A lot of people leaving disappointed. People with conditions we obviously couldn’t help such as adults with abdominal problems, children with cerebral palsy or epilepsy. But for the 4,236 who came through the gate, hope was maintained. They waited patiently to get through the gate. Once through the gate they were met by one of a team of experienced nurses. After listening to the problem, the same answer was repeated many times, ‘I am so sorry we cannot help you’. Selection Day is one of the hardest of the year.

More people are turned way than are accepted for surgery. It is the harsh reality. The need is always overwhelming and we are only a surgical hospital ship. We do not have the skills or resources to help everyone. And even if we did, medicine also has limitations. For the nurses who have to say ‘no’ literally thousands of times, selection day is long and emotionally draining. But for every ‘yes, we might be able to help you, come on in and see the doctor’ ……the hope and expectation in palpable.

At 9.30 am I received an emergency call to the gate to see a child with breathing difficulties. The child was semi-conscious and gasping for breath in a distressed stated. Despite his dark skin I could clearly see he looked blue from lack of oxygen. I thought we could not help him. There could be many reasons for his semi-conscious state, cerebral malaria being one or some other infection that could depress his conscious level and cause him difficulty breathing. We cannot treat medical problems such as these and there was nothing to see externally. I tried to explain this to his parents but they indicated he had a problem inside his mouth. On peering inside I saw a huge mass, the size of a golf ball, completely obstructing his airway. No wonder 2 year old Noah could not breath. We fast tracked Noah to the maxillo-facial surgeon and scheduled him to be admitted as soon as our hospital opened. Exactly one week later we operated on him to remove the tumour. He is now doing fine on the wards and his mother hugs me every time I walk by.

Noah is in bed 1. Hope given at selection day has now materialised. His mother has heard him say ‘mama, mama’ again. Words Noah hadn’t been able to say for months. Words his mother thought she would never hear again. But even here on the ward, the intersection of hope and disappointment is palpable. Little Esther-Michelle lies in bed 15. Actually she isn’t lying, she is sitting up because every time she lies down she struggles to breathe. She is the same age as Noah. She and her mother had high hopes of help. And so did the missionary doctor who brought her to us. But we can’t help her. Esther-Michelle, like Noah, also has a tumour inside her mouth but for complex reasons we can’t help her. She and her mother are a picture of despair. Helpless disappointment is in their eyes. It is distressing to watch. Two other beds on the ward are also occupied by another child and a young adult. Both with inoperable malignant tumours. It has been a week of hope intersecting with disappointment and despair.

For me, I crossed the intersection of the equator with the prime meridian and became ‘royal diamond shellback’. In real terms that means nothing. But I like the phrase. It speaks of something special, something unique. Something to be treasured. So, as my medical world on the ship keeps intersecting hope with disappointment, I am calling each of these precious little ones ‘royal diamond shellbacks’. Despite their physical condition may they, and their parents, know they are unique and special, someone to be treasured till the day they die. Be that very soon or in many, many years. And as doctors and nurses caring for them, I pray we make that known in the way we treat and care for them when our medical skills have nothing more to offer.

And I pray it for us too. May we consider ourselves as, and treat each other like, special treasured royal diamond shellbacks.

(NB names have been changed to protect patient indentity)

Courage to live differently

A few weeks ago, the world celebrated Nelson Mandela’s 95^th birthday. It took courage for him change the destiny of a nation. Many thought peaceful transformation was impossible, but when one man stepped out, it changed the climate around him. Others dared to believe. Courage inspires because it brings hope. I find myself wondering what would have happened if Nelson Mandela hadn't had the courage to follow his dream?

This summer over beers and a curry, someone asked me, ‘Tell me Michelle, what really made you give up your consultant job?’ I think the question they were really asking is: What does it take to follow your dreams? I think it takes courage, passion and a healthy dose of humility.

I share a bedroom with 3 people, I share an internet connection with 400 people at a bandwidth usually reserved for a family of 4, I can’t go out alone, and I don’t earn a salary. It took courage to resign my consultant job, face financial insecurity, and live like this. It takes humility to rely on others and to admit when I have made mistakes. I may not be ‘the best’  or ‘the most qualified’  person for the job, but I am the one that is here. And I am passionate about what I am doing.

Mercy Ships uses hospital ships to transform individuals and serve nations, one at a time. In Guinea, the 10^th poorest country in the world we performed approximately 2,500 operations and treated over 12,000 dental patients in just under 9 months. Initiating sustainable agriculture programs and leadership training for community / government leaders are also examples of how we serve the host nation.  In Congo I have met with officials from the WHO and the Ministry of Health, conducted surveys of the hospital facilities, collated requests for training and presented a Healthcare Education plan to the government for the next 10 months. This is all part of Mercy Ships aim to ‘Follow the 2000 year old model of Jesus, bringing hope and healing to the world’s forgotten poor’. I am passionate about being a part of this dream of helping low income countries improve their healthcare services.

In Sierra Leone, 2 year old Josephine needed life-saving airway and thoracic surgery which no-one in Sierra Leone could provide. Luckily we could provide what Josephine needed so she survived. In Togo, 10 month old Chara was not so lucky, we did what we could but the ship was leaving. Chara went to a public hospital for further treatment but no anaesthetist was prepared to anesthetise such a small baby. I have a dream that ‘luck’ is eliminated and instead, that we can help low income countries improve their anaesthesia services so they can care for children.

Ozzy Osbourne said, ‘any fool can get drunk and trash his hotel room but it takes courage to live differently.’ It takes courage to leave work on time so you get home to say goodnight to your kids, it takes humility to say sorry to your kids or your partner when you put your job before them; it takes courage to press through difficulties in your marriage or relationships with your children, it takes courage to admit you need debt counselling or help with alcohol addiction. It takes humility to ask for help and a passion to overcome difficulties to see your dream become reality.  Dreams start by making a difference to the person right next to you, in your own family, in your job, or the sports club.

Transformed people, transform nations.

Lessons from the swimming pool

I am sitting watching my niece in her swimming class. She is fascinated by all that is going on. She is a beautifully inquisitive and engaging 10month old. She has a gentle and calm disposition. But according to my sister-in-law, my niece doesn't like the bit when they go under the water. Suddenly when the water hits her face she changes. She squeals at the shock. It is as if she is saying 'Mummy what on earth just happened?' It shouldn't have been a shock, she was warned. Mummy told her several times what was about to happen, and so did the teacher, but it was as if she either didn't listen or was simply too fascinated by everything else that was going on to register the instructions. Now her eyes are fixed on mummy, but she doesn't want to have another go at going under the water. Fear of being shocked again has robbed her of the joy she had a few moments ago. But she needn't fear. Her mummy is there, it is totally safe. Mummy loves her. Parents are to protect us and empower us. Empower us in the sense of releasing us to be all we were created to be, releasing us to reach our full potential. Releasing us to be greater than they were. That's why mummy is taking my niece swimming, to enable her to swim so she will be safe around water. Protecting and empowering.

Parenting is a good model of what leadership and authority looks like. Parents have authority over their children. Team leaders in the work place have authority over their teams. Bosses have authority over their employees. However, today we seem to struggle with the concept of 'authority'. The very word provokes strong reactions. And add in the concept of 'submitting to authority' and it sometimes unzips people, rather like opening the lid on a can of cockroaches. This doesn't totally surprise me because when I look around, sometimes I struggle to see good role models of authority. Instead I see leaders (or parents) controlling or holding someone back out of their own insecurity, not releasing others to be greater. Or, at the other end of the spectrum, I see parents pushing children to be something they're not, simply because the parents wished they had been or done that one thing. I see bosses crushing the creativity and suggestions of those below them simply because they are insecure, or trying to build their own empire. I see bosses taking the credit for ideas that are not their own, or blaming employees for something that went wrong instead of owning the responsibility as the leader.

Yes, authority has been abused, in the home, in the workplace and in the government of our land. But just because it has been abused does not mean it is an outdated concept. Quite the contrary. It is a beautiful thing to be under authority that protects and empowers, training you to be greater, releasing you to be more than you are already. This type of leadership is known as servant-hearted leadership. Servant-hearted because it seeks to protect and defend, and ultimately the leader would give up their own life to save the life of another. To protect them. Servant-hearted because the leader lays down their rights to their own desires and pride and serves another, pouring out and investing for the other to become greater.

Sounds like being a parent doesn't it? As a doctor on a children's intensive care unit I  looked after some of the sickest children in England. Many a parent said to me they would do anything to save/help their child. They would literally give up their life it they thought it would help. That is protecting, defending, fighting for those under your care. And in the same way, what mother at home with small children denies that looking after them is a sacrifice? A laying down of her rights to her own time, her own desires etc etc. It truly is a servant-hearted job especially when the children are small. I wonder what your workplace would look like if these concepts were applied there? I wonder what my workplace would look like, if I led like that and embodied this principle?

And now my niece's swimming lesson has finished. Today, she actually went under the water. She didn't squeal, she loved it. I could see the grin of delight on her face as I watched from the seating area. She knows she has a mummy who protects and empowers. And I pray she grows up to be the same. A servant-hearted leader. Someone who protects and empowers.

By the way, Jesus is the greatest role model of this type of leadership. Servant-hearted leadership. So if you want to know more about how this concept works, read his book.

Mohammed's story

I write this having just arrived in the Canary Islands. Our 10 month Fields Service in the Muslim nation of Guinea has finished. I have many memories. My friends favourite story is described by her in the video above (click on the arrow to play). But one of my favorite stories comes from a Muslim man named Mohammed. I first met him in the middle of the night when the emergency alarm went off because his neck had started bleeding. A true life-threatening emergency needing immediate surgery. But that is not the only reason I remember him so vividly. It is because of what he said. Mohammed said, about us “They actually pay to come here so that people they don’t even know can be healed. Who else but God sends people like that?”  . Mohammed's story is told here by one of the ship writers, and his pictures are shown in the right hand column:

Dr. Mark Shrime, a Mercy Ships volunteer surgeon, was recently serving onboard the Africa Mercy hospital ship in Guinea.  One of Dr. Mark’s patients, Mohamed, had such a large growth on his neck that, at first glance, it seemed like a goiter. To determine the exact nature of Mohamed’s condition and to plan treatment, Dr. Mark used the diagnostic information provided by a computerized tomography (CT) scan.

Mohamed had fallen into deep despair. He explains, “As my condition worsened, the growth increased to such a size that I had difficulty eating and sleeping. My voice also became hoarse. My wife worried constantly that this condition would cause me to die.”

Another of Mohamed’s fears had already come to pass, causing the family extreme hardship. He recounts, “The lump on my neck started growing when I was in my mid-twenties. I had worked very hard to complete University studies in law, planning to have a good career in the justice department of the Guinean government. But when I could no longer hide the growth, my career stopped. I had the education and trust needed to take on significant roles, even as a Minister, but my appearance prevented any chance of promotion.” Mohamed was transferred to a local police detachment, with no contact other than the criminals he interviewed.

When Dr. Mark received the results of Mohamed’s CT scan, he was taken aback. According to Dr. Mark, “As it turned out, Mohamed’s problem was not a goiter but a cyst. The condition begins even before birth, when the thyroid gland descends from the base of the tongue through a canal called the thyroglossal duct to the neck. Usually the duct disappears after the gland descends, but sometimes small pockets, called cysts, remain. For Mohamed, and others with this condition, fluid collects in the duct cyst. The result is a visible lump.”  

Dr. Mark had never seen a cyst as large as Mohamed’s, noting that, “This condition is normal, but the growth generally remains golf ball size. Where there is access to surgery, the cysts are usually removed once they become noticeable. But for Mohamed, whose cyst was untreated for almost thirty years, it grew to an enormous size.”

Mohamed learned through bitter experience that he had no access to the treatment he needed. “I spent almost $10,000 (enough to put ten children through University) in Guinea, and other nearby countries, looking for a cure. My family and I did without many things. When I found out that I could get surgery in France, I even entered a competition to be sent to police training school there.” While Mohamed obtained the top score on the selection test, another person was awarded the scholarship to travel to France. After years of unfair treatment in the workplace and ridicule from his colleagues, this final injustice crushed Mohamed’s remaining morale. He left his job, shuttering himself inside his home.

Unemployed and feeling hopeless, Mohamed began a personal prayer vigil. Daily at 2:00 a.m., often with his wife at his side, he prayed for healing and to have his livelihood and life back.  

Mohamed believes that God answered his prayer by bringing Mercy Ships to Guinea. He recalls his remarkable experience as a patient. “Mercy Ships saved me and renewed my life. While I was waiting to hear about my surgery date, a Mercy Ships day-worker who I met at the screening continued to check on me and assured me that I would be called.  All of the volunteers for Mercy Ships were so helpful and kind. When I had my first test, the nurse was careful and made sure I was comfortable. After my surgery, I had some unexpected bleeding in the middle of the night. Within minutes, I was immediately surrounded by nurses and taken to the operating room where many doctors were waiting to fix the problem. I was back in bed sleeping within an hour!” (technically this is true as the bleeding was fixed quickly in theatre but we actually ventilated him on ICU for the next few hours and woke him up in the morning !)

Following his successful surgery, Mohamed returned home a renewed man. He was so impressed by the quality of care he received from Mercy Ships that he wrote a personal account of his entire experience to share with his friends and family. The part that still surprises him is what he learned about Mercy Ships volunteers: “They actually pay to come here so that people they don’t even know can be healed. Who else but God sends people like that?”

Written by Joanne Thibault

Edited by Nancy Predaina

Photographs by Debra Bell, Michelle Murrey, Bright Effowe

Always Learning

I love learning new things. I love new experiences. Maybe that’s why I love being a doctor because one is always learning.  No two patients are ever the same.  Science progresses and we learn new techniques for treating patients, new ways of making surgery safer. Sometimes these things are not huge technological advances but simple things such as using a Checklist to make surgery safer.

At the end of April I spent a week driving through the interior of Guinea visiting 3 different hospitals. (Click on the Page tabs above to view some pictures of the Hospitals and the scenery). I learnt a lot. Each hospital was a 2 day journey along difficult potholed roads, or dirt roads with huge craters. We were fortunate it was the end of dry season. In rainy season some of the roads become impassable, and when the large pothols are full of mud and water it is easy to become stuck! Even in a landrover. Back in November when another Mercy Ships team went this way in two landrovers, one of the landrovers actually became stuck. Thankfully the other one had a winch so could rescue the first vehicle. Driving here is not for the faint-hearted. But when you learn how to drive these roads it is actually quite fun. Oscar, our Hospital Projects Manager had spent two years living in Liberia so he knew these road conditions well. I learnt a lot by watching him.

The aim of our trip was to visit Kissidougou, Kankan and Labe hospitals to follow-up on the training we had given to Obstetric Fistula Surgeons and in two cases their anesthetists and nursing staff as well. We were not so much interested in what particular surgical techniques they had learnt but rather what principles of safe surgery (such as the Safe Surgery Checklist), whole person care and empathy they had learnt through our methods of modelling and discussing these concepts. I was humbled and amazed how much they had learnt and how diligent they had been trying to put it into practice various actions and attitudes. The culture here is described as an ‘honour / shame culture’.  So I knew our visit to their hospitals would honour them. Back home visitors to a hospital can be viewed as a burden - a ‘oh gosh who is going to look after them’ type-attitude. Not in West Africa. Visiting the surgeons honoured them to their Hospital Director, and honoured them in their community and family. But I also learnt that driving two days to visit them showed we cared. It added credibility to our training program. The training program aims to model ‘whole person care’, ‘servant-hearted leadership’ and  to instil ‘individual value and worth even for those with disfigurement or disability’. I learnt that we can model these concepts not simply by the way we treat patients and each other our ship hospital, but also by visiting the trainees in their own environment. These follow-up visits showed we don’t just teach healthcare professionals, we also care about them as individuals.

Medicine treats and cares, Education teaches and cares.

I still have much to learn about teaching medical knowledge, skills and attitudes cross-culturally in West Africa but I learnt an important lesson this week and I am very thankful.

I love the fact that life is one long learning process. It keeps me humble

An Easter Mosaic

The picture shown here is a beautiful mosaic created by Catherine Schwebel. Catherine is one of the chaplains serving on board the Africa Mercy with her husband and three children. She is an incredible artist. Many times I have bought cards with images of her paintings on them. Now she has created this beautiful mosaic picture. It has truly been a labour of love undertaken during lent. She carefully chose the image and outlined the picture. She designed the contents of the picture. The hills, the garden, the two figures, perhaps one is Mary, kneeling. The empty tomb, the angel of the Lord appearing. Catherine had in her mind’s eye the finished product. She knew what it would look like before it came into being. I didn’t. All I could see was a blank white canvass. If I looked closely I could see a faint outline of an angel, a kneeling figure. But I didn’t know the intimate details, the colours, the beauty. But week by week the mosaic took shape. One by one, Catherine selected scraps of paper. Each carefully chosen. The right colour. Actually it was more than just colour, shades and tones mattered. Then each piece was cut. Precisely. Lovingly. And finally glued in place. Not any place, but the exact place Catherine had prepared for it long ago. Long ago when she designed the mosaic.

This mosaic is a reminder of you and me. Each one of us carefully chosen and formed by God. Each piece in the mosaic is different but each is carefully chosen, designed, and set in place. Not any old place, but a specific place. And together all the pieces make up a beautiful picture. If one was missing the picture would be incomplete. So it is with us. Each of us is set in place by God and if one of us was missing, our world would be incomplete. My world is, here on the Africa Mercy. Your world is wherever you are….your workplace, your family, your church. Each one of us is significant, made in the image of God, chosen to reflect Gods beauty. Individually we reflect in part, together we reflect the whole. God knew what he was doing when he made you. Before the full picture was finished , he chose you and made you specifically, lovingly, uniquely. No one else can replace you. He set you in place. You are valuable to him. You are valuable to your world. To the people around you.

This Easter, do you know your significance and your worth before God, the God that died for you and rose again to give you new life? If you don’t believe what I say, ponder the following statements from the bible:

Acts 17 verses 26 & 27 says God

…determined the times set for them and the exact places where they should live

Psalm 139  verse 13 – 16 says about God

For you created my inmost being; you knit me together in my mother’s womb.

…I am fearfully and wonderfully made

My frame was not hidden from you when I was made in the secret place.

When I was woven together….your eyes saw my unformed body.

All the days ordained for me were written in your book before one of them came to be

Esther 4 verse 14 tells us

And who knows that you have come to royal position for such a time as this.

Civil unrest

I am meant to leave the ship this evening to do an airport run. The Africa Mercy has a constant turnover of volunteer staff. Over 1000 people will arrive and depart in a 40 week filed service. That’s a lot of people to take and fetch from the airport. Each department is responsible for picking up its own volunteer’s. The hospital makes up almost half the crew so we have a lot of airport runs to do ! Actually they are quite fun and not really a chore. Sometimes the drive is fun…a chance to feel free and independent, other times you are picking up friends and welcoming them back to the ship; and other times you get the pleasure of picking up new volunteers and welcoming them to the ship. They have a mixtue of nervous anticipation and excitement. I like airport runs.

However, sometimes airport runs are not so much fun. Tonight might be one of those times. There has been political unrest in Guinea for several days now. Ever since we arrived 8 months ago there have been occasional political demonstrations. Most of these do not affect our ship activities, patients can still reach us and we can move around freely in town. Only on rare occasions has our personal or business activities been affected. This week has been different. Yesterday (Saturday) we went on a boat trip to the beautiful islands just off the coast here. It was an outing for all Operating  Room staff including our local workers. However, due to recent violent protests some of the local workers didn’t want to leave home, especially the women. We live in troubled times.

The political unrest here has deteriorated into ethnic violence in some areas. It hasn’t reached main stream news but you can read reports on Reuters News Agency network. The following is a brief summary of what has been happening this month, taken from the news articles on the web.

Guinea is a former French colony, and when President Alpha Conde narrowly won the presidential election in 2010, the election was billed as the first free poll since the 1958 independence. Although the election was marred by deadly riots and opposition allegations of fraud. There had previously been a military coup in 2008, and the transition back to civilian rule is still not complete. The final step is legislative elections, which after much delay have finally been scheduled for May 12^th. These elections are a prerequisite to unlock millions of dollars of frozen foreign aid, and were originally scheduled for 2011 and have been delayed many times already.

Preparations for the elections are being hampered by opposition claims the government is seeking to rig the outcome in advance. The opposition, has called for a number of protests. But meanwhile, the head of the Guinean armed forces, General Diallo, was killed in a plane crash in Liberia on Feb 11^th. He was one of the main architects of the reform of Guinea's powerful military, which seized power in the military coup of 2008. Diallo was a strong supporter of the Conde government, but Diallo's predecessor, Nouhou Thiam, is in prison facing trial for his alleged role in a gun and rocket attack on President Conde's home by soldiers in 2011. During the period of mourning for General Diallo the protests were called off but restarted this week on wednesday Feb 27^th.

In 2010, President Conde promised to unite Guinea in the same way Nelson Mandela did after apartheid in South Africa. But many of his compatriots say he has failed. The opposition protest on Wednesday turned violent and some 130 people were injured. The violence continued and Guinean President Alpha Conde appealed for calm on Friday after rival ethnic gangs fought with knives and truncheons. Reuters reported ‘Security forces in full anti-riot gear took to the streets of the crumbling seaside capital Conakry to try to stem violence in which at least 65 people were injured, according to a statement from the presidency.’ And that ‘Residents of Conakry fled in panic as the gangs from rival ethnic groups roamed the streets. Shops and business were looted in many parts of the city.’

I feel safe on the ship, and we are monitoring the situation closely. Most of the violence is further outside the city than where we are in the port. Guinea is the world's top supplier of bauxite, the raw material in aluminium. However, the economy produces only about $1.50 per person per day despite a wealth of natural resources, including the world's largest untapped iron ore deposit.

Politics are mainly drawn along ethnic lines. The opposition coalition is broadly supported by members of the Peul ethnicity - the country's biggest ethnic group - and the government by the Malinke. Sadly, the political protests now appear to have degenerated into inter-ethnic violence between the Peuls and Malinkes. The US government and UN Secretary-General Ban Ki-moon have called for calm.

To reach the airport, we drive past the Grande Marche area of Madina. This is where there were running street battles between the Malinke and the Puel.

I will await further instructions from the captain and managing director as to who is going to the airport and how we get there. They are very experienced and have all the information they need from a variety of sources. I am confident wise decisions are always made here as Mercy Ships takes crew safety very seriously. So those of you reading this needn’t worry. Reminds me of trusting the Lord. We don’t need to know everything or know the outcome, but what a relief when I have confidence in the authority over me. Knowing they are there to protect, to lead and to guide. I thank God for Captain Tim and Donavan, and pray for them for wisdom, strength and energy as they steer the ship and crew through troubled times. I also pray for the people of Guinea, for peace and reconciliation. For good men and women, people of integrity and courage to lead this nation. The last women in government who stood against corruption was assassinated a few months ago. Guinea needs our prayers.  

Risky Business

Being ill in Guinea, or any country in West Africa, is a risky business.

Your chance of recovery depends on, not just how severe the accident or illness is, but on numerous other factors. Namely:

1.    How close are you to the nearest hospital?

2.    Is the necessary treatment is available?

3.    Do you have enough money to pay for your treatment?

My local hospital in England is under threat of closure. The local MP is campaigning hard to keep it open. It is 5 minutes from where my parents live and if it closes they may have to drive 30-45 minutes to another hospital. That seems like a long way by British standards. Most of the patients I see, live at least that far from a hospital. Some of our patients have travelled 2 days by bus to reach the ship. Even in the US and Canada, patients drive many hours to seek specialist help. Even with hospital closures, we are still very fortunate in England.

A friend of mine was unwell so she saw her GP. He did some blood tests and sent her for further investigation and biopsies at the local hospital. Biopsy results back, the GP started treatment and made a referral to a specialist hospital consultant. Specialist seen, she is now on treatment and getting better. All this within six weeks. God bless the NHS. In Guinea you don't have a local GP, even if you did they might not know what to do. If they knew what to do, they probably wouldn't be able to perform the specialist tests and investigations, because of a lack equipment (surgical or drugs). Doctors graduate from medical school and struggle to get jobs. Not because there isn't a need, there is, but there is no money to pay them. Their knowledge is far less than British graduates and their practical experience even more lacking. Specialist training is virtually non-existant. Only surgery; obstetrics and gynaecology; perhaps paediatrics, but little else. No cardiologists, gastroenterologists, neurologists, different types of surgeons, pathologists, anesthetists, or all the numerous specialities we are used to. In Guinea, you might have a hospital nearby, but you probably won't have the necessary specialist doctors and medical equipment to treat you. We are very fortunate in England.

My brother is moving to to work in another European country. He will have to pay for healthcare. There is no NHS where he is going. Even if his wife takes their baby daughter to the GP they will have to pay. Many first time mothers visit their GP frequently. The baby is not well, the mother is concerned and not sure what is wrong....first response is visit the doctor. That is a good response, it is safe and good for child health.  We don't even consider the cost, because in England we don't pay. It might be different if you lived in Europe or America. But we are English so we don't even consider these things. In Guinea you have to pay for everything. I visited the main hospital in Guinea a few weeks ago and accompanied a surgeon on his ward round. I met a young man who had been knocked over by a motor cycle. He had a broken jaw, and deep wounds on his arm and leg. His jaw needed surgical fixation, and his wounds needed cleaning and dressing in a sterile fashion. It was Friday afternoon. So far, nothing had been done other than apply a few old bandages to his wounds. If the man or his family could raise the money, he would have his operation on Monday, and his wounds dressed properly. If not he would be discharged. Meantime, his family still had to bring him meals while in the hospital. No free hospital meals like the NHS. In Guinea you may have a hospital, you may have specialist but do you have the money? I don't know what happened to the man I saw. In England we don't think about cost. We are very fortunate.

Being ill in Guinea is a risky business. In England we are very fortunate, despite hospital closures and NHS cut backs. We still have hospitals nearby, with highly trained medical staff, working equipment, and you don't pay a penny.

Thank God for the NHS. It might not be perfect but it is better than Guinea, and quite possibly, better than many other countries in the world.

New Year Resolutions or Reflections

Happy New Year

I love New Year but I am not a great fan of New Years Resolutions. I have made to many, only to fail and then be consumed by guilt !
However, I like the idea of New Years Resolutions. I think  New Years Resolutions provide the opportunity for new beginnings. A point in time when we can make a fresh start. Clearly, you don't need to wait for New Year to do that, but it does provide a type of stimulus for thinking:
'this is my goal for this year, what I want to achieve'
or
'I am drawing a line under that and moving on'

So instead of making New Years Resolutions, I like to reflect on events of the last year, and ask God for fresh vision and inspiration for the coming year. And I would like to invite you to take a moment to do the same.

As we reflect, for some of us, last year will have been wonderful, but for others it will have been marked by sadness and grief.

If the past year has been full of happy memories then we start the new year feeling full. Reminded of Gods goodness and love, we can be expectant of more to come because we know God's intention towards us. His intention is to 'prosper us and not to harm us' .
If the last year has been marked by tragedy and loss; broken promises or pain, then the New Year provides and opportunity to draw a line under the sadnesses and start afresh. It is possible to find hope again. God's promise to us is to 'give us hope and a future'.

We read in Jeremiah 29:11-13
For I know the plans I have for you declares the Lord, 'plans to prosper you and not to harm you, plans to give you a hope and a future. Then you will call upon me and come and pray to me, and I will listen to you. You will seek me and find me when you seek me with all your heart. I will be found by you," declares the Lord.

We live in the present not the past. We do not have to be defined by our past. It is possible to live for today, with hope for the future. We live in a hurting world where life can be brutal on hope. But 12 days ago we celebrated Christmas. Jesus was born with a mission to restore hope to a hurting world. Emmanuel, God with us. Lets not forget this too quickly as we (for those of you who are British) take down our Christmas decorations today on the 12th day after Christmas.

Like I said, I am not a big fan of New Years Resolutions, but I have asked God for fresh vision and dreams for 2013. Some are personal. Deep desires and crys of my heart. Others are intensely practical like 'learn French'! I have written them down and asked God to breath life into them, to help me actualise the vision into my mission, to make the dreams into real plans.
Jesus was part of Gods plan to give us a new start. Jesus life was a hands-on practical, dirty, sweaty reality. Beautiful yet harsh. Life-changing but life-costing.

What are your visions and dreams for 2013? What will be your hands-on practical reality in 2013?

Isaiah 43:19 tells us
Forget the former things;
Do not dwell on the past,
See I am doing a new thing!
Now it springs up; do you not perceive it?
I am making a way in the desert
And streams in the wasteland

I pray that you will know and see God making a way where he needs to, ....a way through the desert and streams in the wastelands ..... that you may have hope so you can walk in all the plans God has for you ..... to prosper you and not to harm you ...... in this coming year.

I wish you all a very Happy New Year.