I am often asked the question – ‘how do
you find your patients?’
Answer:
Teamwork and Communication
In days gone by we held a mass screening
at the beginning of the field service. Literally 1000’s of patients would turn
up, sometimes 7000 in a day. It took all the crew to organize safety lines of
patients, to escort them from room to room through the process from: basic
assessment, to a registration station for name and contact details, basic
medical of blood pressure and heart rate, a surgeon assessment, a biopsy or
ultrasound, photographic documentation, and finally a scheduling appointment
station etc. We worked closely with local police to ensure crowd management was
safe and calm and we would use a very large venue such as a football stadium to
host the day. This would yield most of our patinets for the 10 month field
service. Problem was, most of our patients came from nearby. Or even if not,
the country was relatively small and you could reach even rural areas in 9
hours on a bus. This model worked well in countries where the port city was the
capital (or major) city, and there was large scale urbanization. This is the
case in many West African nations.
However, Mercy Ships is expanding, last
year it was Central Africa (Republic of
Congo) and now it is East Africa (Madagascar). And so our strategy has expanded
and adapted to take account of the differences. Namely larger countries, with
less urbanization.
In the last few years we have been
pioneering a new approach – going to where the patients are instead of
expecting them to travel to us. The aim is two fold – first: to really reach
the poorest of the poor, those in rural areas with no access to healthcare;
secondly: to reduce needless travel for those who we know we cannot help and to
prevent patients waiting all day in a line of 1000’s of people, only to be told
‘no, I am sorry we cannot help you’. Most healthcare aid/development work takes
place within a 100km radius of the capital or major port city. We are trying to
reach beyond this and go out further and deeper to the areas of greatest need.
We have a dedicated team of 4 screening nurses
who travel the country and assess patient’s suitability for surgery. Those who
fulfill our criteria are given an appointment card to come to the ship to be
seen by the surgeon on the dockside. We call this surgeon screening. If the
surgeon agrees to operate the patient is given a date for surgery. We have
proven nurses can screen very accurately and 80-90% of patients they bring to
the surgeon screenings are accepted for surgery. But they can’t do it alone.
Madagascar, in particular is a huge country. So, while the screening team have
literally travelled 1000’s of km, (see red triangles on the map) they have been
helped by a number of people:
·
Mission Aviation Fellowship –
have flown them to remote areas
·
Many partners, other mission
organisations, charities, large and small businesses, telecommunications
companies here have spread the word and communicated via radio, TV, posters,
SMS (text messaging)
·
Our own Communications
department have designed posters, written and translated the radio broadcasts
and other advertising material, and set up a FaceBook campaign (FB is big in Madagascar)
·
Senior management have helped
craft the overall strategy and trusted those below them to carry out a very
successful campaign.
A dedicated team of highly skilled nurses can only achieve so much, teamwork and communication can achieve so much more. Reminds me of the WHO Safe Surgical Checklist, a surgeon can only achieve so much, but teamwork and good communication can reduce mortality and complications by up to 50%.
