Christmas - An event for everyone

This is how Christmas seemed to the shepherd:

There were sheepherders camping in the neighbourhood. They had set night watches over their sheep. Suddenly, God's angel stood among them and God's glory blazed around them. They were terrified. The angel said, "Don't be afraid. I'm here to announce a great and joyful event that is meant for everybody, worldwide: A Saviour has just been born in David's town, a Saviour who is Messiah and Master. This is what you're to look for: a baby wrapped in a blanket and lying in a manger. (Luke 2:8-12 )

'God's angel stood among them and God's glory blazed around them'. Every Tuesday morning at 7.30 we gather in the operating room corridor for 20 minutes / half an hour of devotions. This is a time where we sing some songs of worship and then focus our attention on God, his character and his love for us. It is a bit like a longer version BBC Radio 4 'thought for the day'. Every week, the discipline of doing this and committing ourselves to God really moves me. 30-40 beautiful people from all around the world, working in our hospital, all volunteering to serve those less fortunate than themselves. Many of these folks have given sacrificially to come, and have left their own families behind to be a part of our ship family for a few weeks. The other week as I looked at our group I think I saw an angel. Actually I think I saw more than one. As I looked at our group of people, I saw hearts shining, overflowing with love, literally radiating the love of God. Some were burning brighter than others, not because they were actually brighter but because the others seemed covered somehow.....so their light couldn't shine. But as I continued to worship and praise God, I saw the covers being lifted off, it was as if somehow the sound of our praises caused the covers to be removed allowing the lights in their hearts to shine. And I was reminded of this passage of scripture, God's angel stood among them and God's glory blazed around them, and I wondered if God's angel was indeed among us, and glory blazing around us. Blazing with such intensity that we were literally transformed by it, so that his presence in us made our hearts shine. No matter who we were, or what we had done, or not done, his glory transforms us. He saves us from the things that cover us and continue to drag us down. He saves us to make us beautiful and radiant. It was a great and joyful moment to catch a glimpse of the treasure inside each person, even if was buried deep within and covered.....it could be uncovered.

And that is what Christmas is all about. 'A great and joyful event that is meant for everybody, worldwide'. It is a free gift for everyone, regardless of race or religion or wealth or status. The gift of a saviour.......and not just to save us from our sins......Oh no, no, no.......there is so much more to the Christmas story than that. I am talking about something more tangible, more credible. The gift of a saviour to save us from whatever we actually need saving from. Think about it: Matthew was a tax collector and he was greedy for wealth and status, Jesus saved him from that desire 'to have and accumulate' and gave him freedom to give and be generous. Mary was a prostitute, trapped in a situation she probably didn't chose for herself and didn't want to be involved in but circumstances had forced her into. Jesus saved her from the guilt and shame, and gave her freedom to be a women allowed back into society again. Lepers were excluded from society, considered less than human and with no hope of healing. Jesus healed them and gave them back the right to be considered human.

A saviour has just been born and the shepherds were told, 'this is what you are to look for, a baby wrapped in a blanket lying in a manger'. This phrase makes me wonder, what saviour has just been born in your town, close by, waiting to save you? What do you need respite from this Christmas? For the shepherds they didn't exactly expect their saviour to be a baby in a manger.......so as you look for your saviour this Christmas, be ready for the unexpected, be open minded, and let God meet you with his angels and show you his love in the form of his son, your saviour who can rescue you from whatever is troubling you this Christmas time. For the shepherds, salvation was in the form of a baby wrapped in a blanket lying in a manger, I wonder, what unexpected form will your salvation take this Christmas time?

I pray you will see his angels appear to you and his glory blazing around you and you will find the Saviour you are looking for.
Happy Christmas and peace to you.

Surgery starts tomorrow

It is over 5 months since we saw our last patients. Problems with Ebola in West Africa and then engineering difficulties with our ship propellers caused a prolonged long delay and multiple changes in our schedule. But now the waiting is over. At long last, the Operating Rooms are cleaned and ready. Nurses who had been re-deployed to serve in the dining room and galley have swapped their red ‘kitchen’ uniforms and now wear their more familiar blue, pyjama-style hospital  ‘scrubs’. Everything is ready – surgery starts tomorrow.

Three little children are tucked up in our hospital beds. Our waiting is over, and tomorrow theirs will be too. The wait for surgery they never thought they would have. Some are too young to understand. They are simply smiling, enjoying the attention of the nurses, playing Jenga, or blowing bubbles. But their parents know what the future holds. Their eyes hold the wait of expectation. Anticipation of hope, waiting to be realised. Is this really true? They almost dare not believe it. Their child with crooked legs, or twisted feet is about to be given the chance of living a normal life. A free surgery, that will free them from growing up crippled. A future that looks different simply because they will look different.

 Eyes and hearts are full of expectation tonight. And it is not just the patients and their care givers. My heart is full too. I love what I do. I love giving out of what I have been given, to play a part in transforming the lives of adults and children here in Africa. But I won’t be giving any anaesthetics tomorrow – I must wait a bit longer. I have some wonderful anaesthesia volunteers who will take care of the operating room for the next two weeks. My job is to take part in a strategic planning conference on-board and help define Mercy Ships focus and growth for the next few years. Then next week I am in the US for a similar meeting with Lifebox (www.lifebox.org). I love the strategy and planning, it fills me with hope for a better future. But I also love the patients I get to serve here – so truly I am excited to hear their squeals and giggles fill our hospital corridors. Tomorrow, 3 children and 4 adults will get surgery they couldn’t otherwise have had. Just like the grace of God – everything we offer is for free - all our surgeries, all our medications, all the food (for patients and care givers) – everything, even my time, everything  is free.

How did we find these patients?

We have had a week of screening: approx 4200 people showed up. 2588 were seen by a rapid assessment ‘pre-screening’ team (I did that one day); 697 had a history and more detailed examination; and 369 were give appointments for a pre-operative surgical appointment and 204 placed on a waiting list

Our hospital is ready - we are so happy

Extra note for this month...

Click on the tab above - new video - to see a short 3 minute video clip

New Orleans

New Orleans

This year the American Society of Anesthesiology (ASA), a meeting of approximately 15,000 anaesthesia doctors from around the world was in New Orleans. For the last 3 years I have been invited by the ASA to help run the ‘Paediatric difficult airway workshop’ at their annual scientific meeting. 

I had a research background in this topic before working with Mercy Ships and now the work we do is on the ship is highly relevant. As an ex-colleague of mine once put it, ‘we see the world’s most difficult airways’. And I think he is right. For those non-medical readers - management of the airway is a key skill for anaesthetists as it helps us keep you alive when you are under general anaesthesia! And usually this is straight forward, but it can be difficult and if this occurs unexpectedly then your anaesthetist doesn’t have very long to react (literally minutes) to keep you safe. In other situations one can predict that a patient will have a difficult airway and employ various techniques to ensure patient safety – but some of these are complex skills and especially so in children.

This meeting has always been highly valuable resource to me. Not only for attending various sessions to maintain my own continuing medical education (a necessary part of retaining my medical licence) –but also for the people I have met. There is a large community of global health experts at the meeting – all of whom are working hard to make surgery safer in low income countries, discussing how to teach and train and this environment, and what metrics we should be measuring. At this meeting (and the surgical equivalent), there is a coming together of some of the sharpest minds I know.  A trading of ideas and brain-storming of possibilities. This for me is one of the most stimulating and rewarding parts of the meeting and I am privileged to be a part of these discussions. It has honestly helped shape the Mercy Ships Medical Capacity Building Strategy that I have developed over the last 2 years since late 2012. And this year, in New Orleans it was no different.

I could only attended half the meeting due to Mercy Ships sailing schedule but as always, God seemed to manage to connect me with the right people. On one hand I was encouraged to hear that everyone is wrestling with the same issues as we are.  Mercy Ships is doing a good job. We are pioneering the way along with others. There are no experts in this field – we are all very much learning and very much aware of the problems of difficulties. So, on the hand I was fighting discouragement –there are no easy answers, no sure strategy, no ‘quick fixes’. Teaching and training, or to use the buzz words, ‘sustainable capacity building’ is just sheer hard work, and it takes a long time and a lot of effort to see any change.  Someone at Mercy Ships recently asked if we could get an ‘expert’ to come and talk to us about capacity building – I would love that – just don’t know where to find them? I don’t feel like I am the expert, but no-one does.

The other wonderful thing about the ASA meeting that deserves mention is the people I meet. People of good character, passionate about patient safety, passionate about improving healthcare globally and very generous with their time, ideas, skills and resources. Many of them have blessed me personally over the years and generously supported me financially and intellectually. This year was no exception – and I am extremely grateful. Not all of these friends were there this year (there is another big meeting in Boston next month with our surgical colleagues) – but they are never far from my thoughts, and we are in constant contact as we continue to work together.

SO Mercy Ships is headed to Madagascar and we sail from Cape Town on Thursday 16^th, arriving Saturday 25^th October. I am so glad we are nearly there. It has been a long time since our floating hospital was open and so many changes of plan due to Ebola. We have had a manic time getting ready in just 7 weeks. Normally we assess a country at least a year in advance and can start making plans for sustainable capacity building and plan the follow-up metrics arrangements. This current schedule makes things very hard. Not to mention all the other logistics surrounding getting the ship into the port with the right berth space, water availability, customs and container logistics, suitable sites for our off-ship projects such as eyes and dental, transportation issues for crew and patients (port city is 8 hours from the international airport). We are fortunate to have a very capable and hard-working Advance Team on the ground in Madagascar now making all these preparations. And with reference to Medical training – I am so grateful for our Project Manager, Krissy who is there right now, meeting people, and making relationships so we can do as much training as possible and start as soon as possible. It has been exhausting for all involved – both on the ship and on the ground in Madagascar.

New Orleans was an interesting place. In many ways it reminded me of Africa – the temperature, the people. Also, one thing struck me – just outside the cathedral were row after row of mediums, fortune-tellers, people offering to read your palm, or check your Taro cards. I am never sure why we are so fascinated by knowing the future – if I knew how much hard work the last few months had been would I have stuck with it? Often we want to know the good but not necessarily the hard things! Inside the city cathedral were all the trappings and religious paraphernalia one would expect. The whole scene reminded me of the time when Jesus went to the temple (Luke 19: 45-48) and started getting rid of those who were selling things and said ‘my house will be a house of prayer but you have made it a den of robbers’.  Thankfully I can trust my future to Jesus and I don’t need a fancy temple or a fortune-teller to do that for me. The church today is made up of people and not just a building. Jesus doesn’t live in a building he lives in our hearts, and through prayer I can access the mind of God. I don’t need a fortune-teller. I can pray and talk to Jesus anytime, anyplace and he guides me and my life and helps me as I plan the capacity building strategy for Mercy ships. And that is Good News, when, as I said above – there are no 'real experts' to show us the way forward.

'whatever you do for the least of these you do for me'

These are not easy times, but they are incredible times.

We delayed our departure to Benin so we could monitor the Ebola situation especially in nearby Nigeria. The Ebola cases in Lagos were less than 120 km from where our team was preparing for the ships arrival in nearby Porto Novo, (the capital of Benin) and Cotonou (the large port city). However, the Ebola situation in Nigeria was far from contained – as those who have being following the news will know. Therefore we took the decision to cancel the ships deployment to Benin for this year. This was a very difficult decision. But crew safety was important, and also a desire not to worsen the Ebola situation was at the forefront of our minds.

How could we worsen the Ebola situation? Our ship, offering free healthcare, acts like a large magnet. Many people travel great distances in search of help. Countries in West Africa are like Europe, where the national borders are easily crossed and are no barrier to people movement. We frequently care for people outside the host nation who come to the ship, desperately seeking help. So being in Cotonou Benin, where literally hundreds of people cross the border back and forth to Lagos, Nigeria each day, was considered not a wise idea. The best thing to control Ebola is to restrict the movement of people, not encourage it. 

Our Advance team have been in Benin since April preparing for the ships arrival. They have hired approximately 200 local people to help us and had begun training them. Literally hundreds of posters have been distributed, radio and TV announcements were advertising our main patient selection on September 9^th. Applications forms for our healthcare education programs have been collected and two large ship containers were in Benin full of equipment and supplies – ready and waiting for us. Suddenly it is all change.

For the last few weeks this same team have been packing up, and pulling out. The radio and TV announcements now tell people that the patient selection is cancelled. However, some people had already started turning up – so sad. The 200 people hired for the year are being told they will no longer have a job. Thankfully the newly renovated buildings that we would have used for our dental clinic and Hospital Out Patient Extension (HOPE) Centre will still be able to be used. So at least we have left something behind. But then again, I believe it really is more than just buildings that we have left behind.

On one level it seems like we went to Benin and gave the people hope, and then that hope was snuffed out. But that is only part of the picture. We will be back – just not sure when. Benin will remain in our hearts and prayers because Mercy Ships is committed to West Africa and we are committed to serving the poorest of the poor. And now after Ebola, this region will be poorer than ever, especially countries like Guinea, Liberia and Sierra Leone. At times like these I take my hope from the words of Jesus,  ‘whatever you have done for the least of these you have done for me’. So every encounter, every smile, every hand shaken by our Advance Team was a Jesus encounter. A chance when love was shown, hope was sown, and an opportunity for more was born. It isn’t just about Mercy Ships bringing a hospital ship to a city. It is about people having hope for the future. The ship might not have come to Benin, but love did. Love in the form of a small team made up of 8 friends of mine, who poured heart and soul into Cotonou and the surrounding areas. Why? Ultimately because they believe in something bigger than Mercy Ships. They believe in a God who can bring hope and healing in ways the ship can't. Ways bigger than simply healthcare. They believe in a God who can make all things new. They believe love has a face and so do I. And that is one of the reasons I am here and why I do what I do.

And the great things about belief and faith like this is, that despite these very sad, very real, and very devasting consequences of Ebola – love still has a face. Every encounter is a Jesus encounter. My heart goes out to the people of Benin, I have been there twice before and I was looking forward to going there again. And I pray for the opportunity to return. But meanwhile, God is expanding our territory. No longer is Mercy Ships limited to West and Central Africa – we are now headed to East Africa. We will be serving the people of Madagascar instead. They are excited about the opportunity to host us and we are excited to be going. Sadness on one hand for Benin, but on the other hand - so thankful for the opportunity to spread our surgery and capacity building efforts to another part of Africa, Madagascar……here we come.

Extra note: ‘Love has a Face’ is also the title of a book by Michele Perry, which I highly recommend.

Ebola

Mercy Ships made this public announcement a few days ago (August 8^th).  But things change rapidly and since then there have been several suspected cases of Ebola in Cotonou.

As our hospital ship, the Africa Mercy, prepares to leave for its ten-month mission to perform life-changing surgeries and train local healthcare professionals in Benin, West Africa, Mercy Ships continues to be acutely aware of the Ebola situation in the region. The organization is taking appropriate steps to protect its volunteers and staff. In April, Mercy Ships redirected its upcoming mission from Guinea to Benin out of caution for the safety of its crew. Benin has no reported cases of Ebola.

The Africa Mercy is the world’s largest civilian hospital ship, designed to operate as a surgical specialty hospital. It is not configured to provide the type of treatment required by Ebola patients. In addition to having changed its itinerary, Mercy Ships has also implemented strict travel restrictions to the affected areas and will continue to monitor the situation closely, making programmatic adjustments as needed.

Founder Don Stephens commented, “The well-being of our patients and dedicated crew is our greatest priority. It is fundamental to our continued service to the forgotten poor in Africa. Our prayers go out for the countries impacted by Ebola. These are places and people we know well because we have served them in multiple visits over more than two decades.”

Even if the suspected cases in Benin test negative, the threat remains real. We were due to set sail for Cotonou, Benin later this week but we have decided to postpone our departure for two weeks. Simultaneously we are making contingencies plans and praying for God to intervene and curb this epidemic.

For those of you who have been following Mercy Ships and/or Ebola, you will know the epidemic began in Guinea earlier this year, and rapidly spread to the neighboring countries of Liberia and Sierra Leone. Since then it has spread further through West Africa, where like Europe, travel across national borders for people from the region is easy. No visa’s are needed, the borders are porous. Although now there are reports of travel restrictions and various countries in the region have declared ‘state emergencies’.

Mercy Ships was originally planning to go to Guinea for ten months starting this august. But the Ebola outbreak in Guinea unfortunately meant we had to change plans at the last minute and divert to Benin. Last minute changes are a lot of work and our team currently in Benin has been working hard for the last four months building relationships and making everything ready for us to serve there. With confirmed cases of Ebola in Lagos, Nigeria approximately 2 hours away the possibility of confirmed cases in Cotonou is very real either now or in the future until this outbreak is under control. For those reading this who are intending to work with us in the next field service, know that crew safety is the highest priority for Mercy Ships.

The Ebola outbreak is unprecedented.

It is an extraordinary situation, and extraordinary situations require extraordinary solutions.  

So please pray for wisdom for me and the senior leaders of the organisation as we decide the best way forward.  The safety of our crew IS the priority. Our mission IS to follow the 2000 year old model of Jesus bringing help and healing to the forgotten poor. These two statements are not incompatible, even in the face of Ebola, and I will use all the skills that God has given me to ensure we do both to the highest level possible.

Learning French

I spent the month of June in Lausanne learning French. There were moments when I really thought, ‘this is one of the hardest things I have ever done!’ and then other moments when I was overwhelmed by the beauty of things I was experiencing.

Why French? For the most part, Mercy Ships works in Francophone countries in West Africa. The working language on board our ship is English, but for training doctors and nurses on the land we must work in French. One can use an interpreter but to make lasting relationships you need to connect with people and that requires communication. I know communication is more than simply the spoken word, it is also actions, for example, the words we ‘say’ with our smile or our touch. But words do bring extra depth. They permit sharing thoughts and feelings, emotions, all the things we treasure in a relationship. And without them, there is only so far a relationship can go.

In a teaching context, I can teach knowledge and skills using an interpreter, and attitude can be modelled. But if I (or you) reflect back on the people who have influenced us most in our professional or personal lives, it isn’t just the academic things you remember people for. Often it is because someone took a personal interest in you, and somehow helped you discover more about yourself and released you to fulfil your potential. It is personal, and that is why I want to learn French. To give to the people we train, something more than just academic knowledge, to get to know them as people and encourage them to reach higher than they dreamed before.

Why Lausanne? Simply because Mercy Ships has an office here and I have friends here. What a good decision that was – I had no idea how much I would need a good friend beside me. I was told recently that I talk a lot….I wasn’t aware that I did….but now I know it is true! When I arrived here and couldn’t speak, it felt like I was suddenly muted. When you can’t speak, you can’t express yourself. Normally I love meeting new people and enjoy finding out who they are or discussing things in a work context. But that was impossible. And it felt so un-natural not to say anything. There are those people who will go out for an evening with friends and not really say anything…..I am not one of them…..but I became one of them…and it felt awkward. Also, I am not a natural linguist. I found scientific things much easier at school, and I am also a little bit tone deaf. So, if I hear a music note, I can’t reproduce it. That makes it a bit tricky learning a new language. The French sounds ‘en’, ‘on’ and ‘an’ are not easy for me to hear the difference, let alone reproduce it when I speak, neither are the verb endings –é and –ais. Some of you reading this will be laughing….but it is true. I have really found this difficult.

I was in language school from 8.30 – 14.30 and would come home and do 2-3 hours of homework and practice. In many ways I worked harder than I did for some of my medical exams. But I absolutely loved it, although there were days when I found myself in tears. The feeling of being mute, and incapable of expressing myself was humbling. Every single day I was out of my comfort zone, and I didn’t want just to resort to speaking English, which would have been so easy here, as everybody speaks English! I set my standards high and gave myself little challenges like getting my haircut and speaking to the hair dresser in French ! And gradually despite the tears, I could see my progress. I was actually surprised how quickly my oral and written comprehension improved. Speaking though was, and still is slow…..the brain has to think so much quicker when you speak! Especially someone like me who likes to speak! 

I have been very lucky to be living with a friend, during the 4 weeks at language school. Sophie is from Lausanne, and we worked together on the ship for almost a year. She has been (and still is) a faithful and committed friend. She was generous with her time, driving me all the way into the city centre for my first day at school, and then helping me find my way around the city to various other meetings for Mercy Ships. She was patient with me, speaking French slowly at home most evenings, but still allowing me to speak in English when I was tired or frustrated! She graciously included me in most of her social activities with her friends and family and church. There I heard French spoken continuously and everyone was extremely welcoming. I also enjoyed meeting with the staff in the Swiss Mercy Ships office and I think they valued being able to meet a doctor from the ship. Several of Sophie’s family would also often correct my poor grammar in a way that was kind, helpful and not destructive. We did many fun things on the weekend such as climbing mountains; going to the Carabana Music Festival & Montreux Jazz Festival, eating fondue, drinking rose, celebrating Philippe and Francoise’s 40^th wedding anniversary, watching French movies and the World Cup. More than all I could ask or imagine. Good memories of beautiful experiences adding immeasurable value to the language learning.

So after 4 weeks I have learnt some French, and have acquired the necessary tools to help me with the next steps of increasing my fluidity in speaking and expanding my vocabulary. And instead of just ‘gritting my teeth’ and surviving, I have many precious memories of time with a friend and her family. 

After the rain, when there is sun, a rainbow appears. After my tears, there was joy, and then heaven appeared. I think that this month, I found the pot of gold at the end of the rainbow. 

June: goodbyes, sailing and more

What do you think of when you think of the month of June?

If you live in Cape Town you will be preparing for a dusting of snow on top of Table Mountain. Brrrrr! Go warm yourself beside an open fire.

In England, I think of English summers, strawberries, raspberries, and long evenings. And because I love sport I think of the various English sporting events that take place, Royal Ascot, the Derby, Henley, Wimbledon, and the various triathlons that I used to enjoy. But now, volunteering with Mercy Ships, June has become synonymous with two things. Firstly goodbye; and secondly, sailing.

Mercy Ships has an annual rhythm whereby we spend ten months in a country from August until June. Therefore June is always the time to say goodbye to people who have become friends. People in the host country and on the ship. Many crew members have written about the goodbye phenomena and how it feels, ‘holes in my life….created by the absence of people I love’; ‘like my heart is getting ripped out of my chest every time I say goodbye’; ‘why is this so hard?’; ‘I feel like I have an emotional hangover’.

Different people cope in different ways. I always try to take the attitude, ‘I can’t keep the best people here all for myself……I have to share them!’ I like to think I am releasing them to the next thing with every good wish and blessing, and however much it hurts I trust myself to the ONE who will never change or leave.

But after all the goodbyes, the ship sets sail. This is a beautiful time. A time for resetting the compass, literally and metaphorically. The Captain must check the compass and do a series of manoeuvres once we leave port to reset the compass and set the new destination. I do the same metaphorically. I use the sail as a time to reflect on things past and reset my bearings for what lies ahead.  The vastness of the ocean helps me do that. It creates the space to think.

The Africa Mercy set sail a few days ago from Pointe Noire for the Canary Islands, a fourteen day sail. However, this time I am not sailing with the ship. I have missed the beauty of the ocean and the thinking space it provides. I flew home a week ago to start language school in Switzerland, so I have had to create my own space instead. Space is in many ways a state of mind. Even in the midst of the business of last week in England and all the changes as I adjust to life in yet another foreign country, space is possible. And I am continually reminding myself to reset my compass. To make sure my foundation is secure so that as I start with the end in sight I know I am headed in the right direction. My crew mates on the Africa Mercy just crossed the point zero zero, where the equator meets the Greenwich (prime) meridian. I missed zero zero this year, but last year I sailed here on my birthday and I wrote about it on my September 2013 blog entitled 'Intersection'.

I am grateful for the last month. I don’t like goodbyes, but I do like sailing and I need the opportunity it gives me to check and reset my compass. What are you grateful for this month?

Note: None of the above photos are mine - they are all courtesy of various members of the Africa Mercy crew, including Josh Callow, the amazing Mercy Ships videographer who recently wrote a very heartfelt blog about goodbyes called 'The pieces of my scattered heart' which is well worth a read and describes the emotions far better than I can  www.josh-callow.blogspot.com

Best weekend ever

Last weekend I spent the weekend with Catherine and Julian. They live not far from the ship in a beautiful house that Julian built, and they had invited Krissy and I to spend the weekend with them. 

Neither of us was sure if we could spare the time. Both of us were behind on work after a busy week and I had to leave at 11am on Sunday to drive to the airport to pick up four British doctors who were helping us run one of our healthcare education courses. However, there is always ‘more work that can be done’ and I needed the break.

Within minutes of arriving we were in the pool, cold drinks in hand and feeling the sun on our backs. Catherine and Krissy were speaking French and translating the bits I didn’t understand. I have been trying to study harder recently in preparation for language school in the summer and I could feel the benefit.

The ship has a hairdresser but she left recently and my hair desperately needed cutting. I had resorted to ‘wearing it up’ as most girls do when their hair has lost any semblance of style! I intended to wait to get it cut until I go home in June, but the subject came up in conversation with Catherine. SO while we were still in the pool, Catherine leaned over, grabbed her phone and rang Eveline, her hairdresser, and arranged an appointment that afternoon.

With refreshingly cool water running over my head and Eveline massaging my head, I began to relax. As Eveline chopped into my mop of hair, I trusted she knew how to cut western hair because she was recommended by Catherine! Blow drying wasn’t an option, the electricity was out (common occurrence in Africa) and Eveline joked with me saying, ‘put your head outside the door and it will dry quicker!’ 

Best haircut ever. Thanks to Eveline.  And she didn’t charge me a penny. ‘Its nothing’ she said, when I asked her the cost, ‘You are from Mercy Ships’.

Twilight walk on the beach at Malonda Lodge, and more French conversation so that my brain felt liked it was being squeezed until there was nothing left! Think I fell asleep in the car on the way home.

Thankfully the evening’s dinner party was conducted mostly in English with friends of Catherine and Julian. As six of us sat around the table we represented 6 nationalities, French, Congolese, English, America, German and Bosnian. Catherine’s husband Julian is Congolese. He was born in Brazzaville after his father had fled there with the remains of the French government and military during World War II.  His mother came to Brazzaville after she was released from Auschwitz aged 18 years and weighing 18 kg.  She was actually on route to Leopoldville (now called Kinshasa), in the old Belgium Congo, but never made it across the Congo River because she met and married Julian’s father. Julian is a great story-teller and in a mixture of mostly English and some French, tales abounded as we drank French champagne and ate Moroccan food, with Krissy and Catherine acting as translators when necessary!

Julian and Catherine met flying. And that was what was on our agenda for Sunday morning. They are both pilots and fly microlight planes. Soon I was flying an aqua-plane with Julian’s brother Robert, while Krissy flew with Julian.

We flew over the coastline, and saw all the ships and oil platforms just off the coast which were familiar from the sail into Pointe Noire 10 months ago. And I held the joystick as we flew over the Mercy Ship which looked small as she sat in the huge harbour.

And our aqua-plane with Robert and I, landed and took off again on the lagoon at Malonda lodge. That was my favourite part. The flight was stunning. Now I can understand the attraction of flying light aircraft. Having been here for 10 months it was an amazing experience to be able to see things from the air and recognise familiar places.

Safely back on terra firma, and one final luxury: an excellent expresso coffee, some water to rehydrate and then it was time to leave.

It was almost 11 o’clock and time for my airport run – best 24 hours ever.

Thank you very much - Catherine and Julian – may God bless your abundant generosity.. 

Do you floss your teeth?

It is one thing to know what you should do, yet quite another thing to actually do it.

I know I should floss my teeth regularly ……but do I do it?

I know I should exercise regularly, eat healthily and have 5 portions of fruit and veg per day – but do I do it ALL the time…..or just SOME of the time…..or NEVER !!

For the last 18 months I have been attempting to create the strategy, then design and implement a new Mercy Ships Healthcare Education Program in the Republic of Congo, and I have learnt a lot. One thing I keep coming back to is the idea that education and training is fundamentally about behaviour change. An education program can increase knowledge and skills, but if we don’t apply those skills through a sustainable change in our behaviour then there will be little long term change. We all know we should eat healthily, take regular exercise, floss our teeth etc, but how many of us actually do it all the time? It is hard to change / modify our behaviour. It isn’t enough to simply know what is best.

The World Health Organisation (WHO) 2nd Global Patients Safety Challenge is called Safe Surgery Saves Lives. They have designed a Safe Surgery Checklist to make surgery safer. The checklist is based around 6 key steps to check:
1. you have the right patient for the right procedure
2. the anesthetist has done a risk assessment for placement of the breathing tube
3. the anesthetist is using a monitor to keep an eye on the oxygen levels in your body
4. the team have evaluated the risk of major blood loss
5. antibiotics are given on time
6. that swabs and instruments are counted at the end of the surgery to make sure nothing is left inside the patient.

These are pretty basic things that most people think they do all the time. But when this was studied in 8 countries (England, US, Canada, NZ, India, Philippines, Jordan, and Tanzania) they realised these key steps only happened 1/3 of the time….and that wasn’t just in the low-income countries! A simple checklist helped improve behaviour so that these 6 steps were done 2/3 of the time. Still not ALL the time. But even doing it 2/3 of the time led to a reduction in mortality and infection rates of almost 50%. Wow! Unbelievable. Not new drugs or equipment, but simple behaviour change can improve health! And that is good news for where I work in West and Central Africa because it doesn’t cost much, and it is something everyone can do! BUT behaviour change is difficult.

Using a locally adapted version of the WHO safe surgery checklist has been mandatory in UK hospitals for several years, but still doctors and nurses are resistant to it. Studies of hand washing in hospitals are the same. Everyone knows they must wash their hands, but time and time again, studies show health care professionals do not do what they are supposed to do.
Why is that?
Perhaps it is the same reason you and I do not ALWAYS, ALL THE TIME take regular exercise, eat healthily and floss our teeth. Behaviour change is hard. I think we need a significant event or relationship to motivate us. Rather like if I suffered a heart attack and nearly died I would be more likely be motivated to modify my diet and exercise regime. Or if my spouse was a dental hygienist, out of love and respect, then perhaps I would probably be more likely to floss my teeth regularly? Relationship and personal relevance are, I think, some of the biggest motivators for behaviour change. So, these are some of the foundation stones of the Mercy Ships Healthcare Education strategy. Relationship and Relevance. Our training program aims to train the whole surgical ecosystem – surgeons, anesthesia, OR nurses, ward nurses, sterile processing technicians etc.

I am immensely proud of what we have done and still continue to do in the Republic of Congo. Recently we took a team to Dolisie Hospital (check out the pictures above). This was a partnership with Lifebox www.lifebox.org and SPECT www.spedc.org We aimed to provide individual education for the anesthetists, OR nurses and Sterile Processing technicians and help them create their own version of the WHO safe surgery checklist. We built relationships, showed the relevance to them of how something simple can save lives, and tried to impart knowledge, skills and professional attitude. We all worked hard and by the end of 4 days we were proud to help them present their own checklist to the Hospital Director. We will return in 6 weeks to encourage them and see how things are going. Behaviour change is hard. We all need encouragement.

Since we returned from Dolisie, I have eaten healthily but I haven’t been running, nor have I flossed my teeth. (oh dear – my uncle is my dentist so there’s a confession!) I have only done 1 out of 3 things I know are important. My prayer for those at Dolisie is that they might do better than me. I hope they will have been able to do more than one of the 6 checklist steps that are important. I do not expect them to achieve everything. Behaviour change is hard. But we will go back to encourage them and continue to build relationships and share our hearts desire – that we all become better doctors and nurses so that we can serve our patients better and make health care safer.

Footnote: This last month we also ran an anesthesia course called SAFE Obstetric Anesthesia in association with AAGBI. Some good photos can be found on a friends blog www.stephcongo.blogspot.com She is a French lady who lives in Ottawa and came all the way to help translate for us and serve the people of Pointe Noire, by helping to train anesthetists.

Ditto

Ditto. Or…… I could say ‘same again’. This month has been a repeat of last month. One where I felt God’s hand on absolutely everything, and I am not quite sure how I got through all I did. A healthcare education assessment visit to Guinea, a Program’s Conference (reviewing lessons learned and making future plans), a visit to Ghana for the West African College of Surgeons Meeting, and an International Maxillo-facial Surgery Conference here in Pointe Noire. I have given several talks and written several reports. I am tired but satisfied. When I started with Mercy Ships over two years ago, many of these things were mere ideas. It is amazing how far we have come, and I am grateful to so many people who have made it happen (over 100 crew members alone have helped with our one-on-one mentoring education projects). And that is just the tip of the ice-berg. I am also in awe of how ‘things or coincidences have just happened’, such as conversations occurring in the right order, chance meetings, being in the right place at the right time……it is the upward spiral of synergy. Or you could look at it another way and call it the reverse phenomena of the ‘swiss cheese model’ of medical errors (for those familiar with Medical Risk Analysis) I could go into more details but I thought I’d share something else I have been musing on. I remember what used to happen when I needed repairs or building work done around my house back home. I didn’t want to get ‘ripped off’ and always wanted a good deal on the price, but at the same time I always wanted the builder to earn a good wage. I wanted him to make good money, enough to feed his family and still have enough to be generous to others. I never felt these two aims were mutually exclusive. I have always believed it was possible because it is God’s heart for everyone to ‘prosper them and not to harm them’. That means me AND the builder. Stephen Covey would call this a win / win situations. Stephen Covey is the author of the best-selling book called ‘The 7 habits of highly effective people’. It was suggested a few years ago that I read this book as part of my Personal Development Plan for my NHS Appraisal (essential for my medical license). I highly recommend the book and I re-read it in preparation for some of the things on my plate this month. As I this last month unfolded, I found myself watching and using many things I had learnt from the book! The book also gave a terminology to things I had always intrinsically believed but never articulated so eloquently, such as win/win scenarios with my builders. ‘The 7 habits of highly effective people’ literally describes 7 principles or habits by which to live your life. The first 3 habits centre on Private Victories, based around being proactive, having vision and purpose and being disciplined in achieving these things. The next 3 habits relate to Public Victories and involve win/win scenarios, synergising and most important of all, seeking first to be understand before being understood. And finally, the 7th habit is an all encompassing habit which is about taking care of yourself. Not in a selfish way, but in a kind of biblical ‘love your neighbour as yourself’ type way, ie if you cannot love yourself and take care of yourself how can you do it for others. We must learn to value ourselves and our time. The book was first published in 1989 and has remained a best-seller for over 20 years. The principles and habits described have remained successful across a generation, and that is an achievement in itself as culture and work ethic changes. At the end of the book, Stephen Covey writes a personal note which says: ‘As I conclude this book, I would like to share my own personal conviction concerning what I believe to be the source of correct principles. I believe that correct principles are natural laws, and that God, the Creator and Father of us all, is the source of our conscience. I believe that to the degree people live by this inspired conscience, they will grow to fulfil their natures; to the degree that they do not, they will not rise above the animal plane. I believe that there are parts to human nature that cannot be reached by either legislation or education, but require the power of God to deal with. I believe that as human beings, we cannot perfect ourselves. To the degree to which we align ourselves with correct principles, divine endowments will be released within our nature in enabling us to fulfil the measure of our creation.’ I share these beliefs. I need the power of God to help change the darker aspects of my human nature. I cannot perfect myself. And I need divine endowments to help me do what I do, and to fulfil my nature and my destiny. The word of God stands forever and the principles in the Bible are true and useful for all aspects of our lives. Physical, mental, emotional and spiritual. As we align ourselves with these principles, we begin to fulfil our destiny and live as we were originally designed to live. Success is released in our own lives and the lives of those around us. I saw that this month. Just like last month. And what about next month…..something tells me I will be saying ‘Ditto’ …… all over again.

Explaining the inexplicable

Unexpected champagne.....warm crusty bread, Camembert, Gruyere cheese, red wine, chocolate mousse, coffee, more chocolates.....and unlimited free Internet access courtesy of the african airline, Air de Côte d'Ivoire. In the west we use words such as 'luck' or 'chance' or 'fate' to explain the inexplicable. Many people are uncomfortable with something being inexplicable. We want answers, we want to understand. Nothing wrong with that. But why, in a rather bizzare way, when we cant explain something, do we make up another inexplicable concept and call it luck or fate. What is luck and who gets it? What is fate and how do you get good fate not bad fate? Where I work in Africa, people don't believe in abstract concepts such as 'luck' or 'fate'. It is more personal. It is all in the hands of the God or gods, so the fundamental question when things happen is, 'who did this to you?' When bad things happen the mindset is often 'who cursed you?' And when one encounters a series of 'lucky events' the response is 'wow what favour you/I have!' What do you think? I ask because I am interested in how you might interpret the week I just had? Good luck or bad luck? Fate? Miracles? Blessings or curses? You probably know what I believe, but I will tell you at the end! I am writing this on a plane to Conakry, Guinea having travelled from Pointe Noire, Congo via Gabon, Ivory Coast, and Mali. Five flights and I am sitting in Business Class, seat 1A, having just been served champagne, European cheese, wine and chocolate truffles. My chair is so big and deep that my feet barely touch the floor and if I sit back in this giant seat my thighs are not long enough to reach the edge of the seat so my knees can bend properly! I was finally on route to Guinea three days later than planned. On Monday evening we had an emergency in the Operating Room (OR), which consumed my whole week and delayed my trip to Guinea. Simon was a young man with a severe abscess in his jaw which needed surgical intervention. When the team woke him up and removed the breathing tube from his mouth he suddenly and unexpectedly could not breath. A crisis call to the OR came over the ships loudspeaker. None of the 4 anesthetists including me were unable to reintubate the young man (put the breathing tube back in). It was also very difficult to assist his breathing using a mask or other airway device. So two maxillo facial surgeons performed an emergency tracheostomy (cutting a hole in his windpipe to place a breathing tube) just in time, to save his life. Simon had a lot of blood and pus in his lungs and we tried as best we could to wash this out and then supported his breathing using a ventilator (breathing machine) and kept him asleep with sedation and pain killers. We had great difficulty keeping him alive even with all our equipment. Even in England it would have been a struggle as his lungs were so damaged they could not absorb the oxygen well enough. I really thought Simon might die. So we cancelled my flights to Guinea, the team would have to go without me. Patients come first. Now was not the time to be planning future healthcare education when someone's life hung in the balance. Many people were praying for a miracle. By Thursday morning Simon had made a miraculous recovery, his airways pressures were lower, oxygen requirement halved, drains no longer bubbling and saturations the best for the last 3 days. At 5pm Friday (4 days after the emergency) he was sitting in a chair, without any of our machines and communicating with sign language. A miraculous recovery and I have not seen one so fast and neither had Alan, another consultant anaesthetist and intensivist from England. We all think we witnessed a miraculous recovery. From my perspective it was a busy and stressful week. Responsibility and worry on weighing on my shoulders. And then there was the visit to Guinea. Three of us were going to re-establish relationships with the Guinean government, port and logistics, and make a more formal healthcare education assessment (my role). The other two had left early on friday without me and my ticket was now booked for Sunday evening with teh remaining connections on Monday. That felt like good luck....or could it be miraculous provision on a more personal level? Simon was better, and I now had time to catch up on some much needed sleep. Fate or favour? And the story continued with the provision of free Internet at the guest house on Sunday evening after I flew to Brazzaville. Monday morning, free unlimited Internet at Brazzaville airport ( better than the with 45 minute time limit at Heathrow). Then my flight from Abidjan was cancelled so I was put on a later one, given a VIP pass to the airport lounge and upgraded to Business Class. Hence the champagne.....warm crusty bread, Camembert, Gruyere cheese, red wine, chocolate mousse, coffee, more chocolates ! All the free Internet access and flight delays meant I managed to catch up with all my backlog of emails and design some more training plans. Was this my lucky travel day....was the patients recovery just fate.....maybe? Or maybe there is a God who knew what I needed? God doesn't make people sick, that is the work of the evil one. But God does work all things together for good for those who love him. God worked a miracle to save Simon's life, I got a weekend I didn't deserve but did need, and even played a game of tennis and went swimming. Gods favour was on my travels, redeeming my time. I took 5 flights and ate 4 croissants (courtesy of the French influence on African airlines). I believe that God worked it to save Simon's life ( we don't normally do his type of emergency surgery on the ship), and so that I could still travel to Guinea and not be totally exhausted. We are building relationships in Guinea and asking them what would they like us to do to help, not just with surgical services but also with training. The saying 'give a man a fish and feed him for a day, teach a man to fish and feed him for a lifetime' has never been more true. One of our objectives in Guinea is to seek to understand what the training needs are as perceived by the ministry of health, the hospital directors, and individual doctors/nurses/other departments. Then we can try and match their needs to our training resources. Training is about change, not just of systems but of ourselves. And that is part of our vision, to 'transform individuals and serve nations one at a time'. That's why we are here. That's why I am here. And even though it is actually incredibly difficult to make a difference, to see the application of the things we teach effect lasting change, it is worth the effort. I believe in a God who really can do 'more than all I ask or imagine according to his power at work in me'. I am very grateful for the miracles I have seen this week in Simons's life and in my life - in real, tangible and personal ones that God gives me because he loves me. You see, I believe God is still performing miracles today. He hasn't stopped and he never will. What would it take, I wonder, for you to believe the same? To believe His love for you and his desire to bless you in the same intimate and personal way.

Grace

This month story is written by Catherine Murphy one of the ship writers, and I have added a few medical details and personal reflections at the very end. I have chosen this story because it typifies why I do what I do and have chosen to serve with Mercy Ships. Grace was one of our first patients up the gangway in Congo. On September 10th, we removed the massive tumor from her face. It’s been several weeks since her surgery, but 17-year-old Grace is as sassy as ever – and she’s looking like a whole new young woman. “God is good because He did a big thing for me. I did not believe that I could be saved, but God has had grace. Mercy Ships arrived in Pointe Noire, they treated me, and I am better today,” Grace says. Grace’s journey to the Africa Mercy began with an email. A hospital chaplain from neighboring Democratic Republic of the Congo met Grace at a hospital there. The chaplain, Pastor Gregoire, was shocked by Grace’s facial tumor, which weighed 4.9 pounds (2.2 kilos.) Pastor Gregoire came alongside Grace, counseling and praying with her. He says she was often so distraught that she cried all night. Sometimes she refused to eat or drink. “Indeed, she suffered,” he says simply. Pastor Gregoire took a photo of Grace and published it on his blog. A reader responded to his post, recommending that he visit mercyships.org, an organization that might be able to help. From there, Pastor Gregoire contacted the Mercy Ships Swiss office and exchanged emails with Christophe Baer. Through Christophe, Pastor Gregoire sent Grace’s medical records and reports to the Africa Mercy. The response was positive. Grace and Pastor Gregoire were asked to arrive in Pointe Noire, in the Republic of Congo, on September 2nd. Grace’s story is a chain of mercy forged by compassionate hearts, and their efforts were rewarded. She has been recovering in the Mercy Ships Hospital Out Patient Extension Center (HOPE Center), where she has become the champion UNO player. As Mercy Ships nurses will tell you, Grace dominates every hand – and don’t even think about challenging her to Jenga! Grace’s tumour was involving her jaw bone, so the first surgery (hemimandibulectomy) removed the tumour and replaced the jaw bone with a metal titanium plate. Three months later the second stage of the surgery takes some bone from the hip and puts it around the metal plate. The bone they grafts onto the metal and gives the jaw back it’s shape. This procedure is called an ‘iliac crest bone graft’. It is done three months after the original surgery to allow the mouth wounds to heal and to reduce the chances of infection in the new bone graft. Grace had this procedure (her second operation) just before Christmas. And she is recovering well on the ward and always says ‘hello Dr Michelle’ whenever I walk by. She is a very happy lady who brings joy and hope to the ward and the other patients. Near Grace’s bed lies, Angelique. Angelique is 22 years old and has a large tumor, rather like Grace, but Angelique’s tumour is coming from her cheek bone (maxilla) instead of the jaw bone (manidible). In a few days we will operate on Angelique and Grace will be discharged. This is why we are here. This is what I have spent the last two years doing. Someone once said, ‘transformed people, transform nations’. In another month, Grace will return home and begin school. She wants to be a nurse. May she go on to do that and transform many others people’s lives through what she does.