How do we find our patients?

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%.