Screening

On Monday, September 3^rd, more than 4,300 people waited in anticipation, forming a long queue outside the People’s Palace in Conakry, Guinea. They were looking for help from the Africa Mercy.  It was screening day.

Some waited through the night, but most started arriving from 5am. A few crew members from the Africa Mercy walked the line, gently dismissing those we clearly could not help. Over 3500 were allowed inside the gates and queued to see experienced nurses who further screened out conditions we could not help. Around 1000 people were allowed entry to the building and registered. Contact details recorded, histories taken and finally examination by a surgeon. All specialties were represented in the long lines of people desperate for help: Orthopaedic, Maxillofacial, Plastics, General, VVF, Eye and Dental patients. 

For those turned down for surgery, the disappointment was tangible. Hopes raised over the hours of queuing were then shattered. But African culture values the community over the individual. So, most people seemed grateful we there, because even if we could not help them, we might be able to help the person sat next to them. It was humbling to witness this selflessness.

Some patients required biopsy or blood tests before a final decision on surgery was made.  Those with end stage cancer (on biopsy) were refused surgery and instead referred to our palliative care team, who will follow up and visit the patients in their homes.

 Finally, the lucky ones, went to the scheduling station. Here they received an appointment for either surgery or further investigations such as x-ray or CT scan, on board ship. For these ‘chosen’ ones, their appointment cards are treasured possessions, reflecting hope, where previously there was none.

By 6pm it was growing dark and there were no lights in the building. We continued working using head torches but by 8pm there were still 100 patients still waiting for biopsies/review by a surgeon. We decided to stop, and bring the remaining patients to the ship a two days later to finish the assessments. BY the time we packed up it and returned to the ship it was 9.30pm. Over 200 patients had been scheduled for surgery, with nearly 1,000 others scheduled for further evaluation or treatment.  This represents our first few months of work. Later on, we have an ‘up country’ screening for patients from the northern and eastern regions of the country. And constantly throughout our time in Guinea we will receive referrals from local hospitals, government officials, and simply word of mouth as desperate people turn up at the dockside seeking help.

On Wednesday September 5^th,  the remaining patients were assessed and by the end of the next day, 3 babies had had their cleft lips repaired, other children had burns contractures released, and several young men had hernias repaired…… hope and healing truly was on its way.

It is a privilege to be able to help, but I am so aware that the need in Guinea far exceeds our capacity to meet it. As surgery began in the hospital on Thursday, a mother came to the Dental Clinic for treatment. She brought her one year old daughter with her who had bilateral club feet.  Why, oh why had she not brought her daughter to screening on Monday? Our orthopaedic surgery schedule is full……we cannot help her daughter now. If only, she had turned up at screening on Monday, then we could have helped her……if only…if only… if only. That is the harsh reality here. Thousands queued on Monday, desperate for treatment, desperate for hope, desperate for someone to care. More went away disappointed, then we were able to offer surgery to. But I hope we reflected care and compassion to every person we saw. The mission statement of Mercy Ships is:

 Mercy Ships follows the 2000-year-old model of Jesus, bringing hope and healing to the world's forgotten poor

Guinea is over 95% Muslim, but Jesus is mentioned over 90 times in the Qu’ran. To Muslims, Jesus is ‘the greatest healer’, as he acted with compassion and actually healed people. So Jesus is a good example for all doctors and nurses to follow, whatever your religious beliefs. So that is why, even in a Muslim nation, the mission statement of Mercy Ships remains entirely appropriate.

The vision of Mercy Ships is:

Mercy Ships seeks to become the face of love in action, bringing hope and healing to the poor

 I believe we embodied that this at screening on Monday and I believe that is why the Guinean government have invited us here. I pray for the strength to hold true to the vision.

Icebergs

I am struck by the beauty of icebergs. Each one is unique, and constantly changing. On a sunny day, against a backdrop of blue sky and an even deeper blue coloured ocean, rays of light catch the ice crystals and are scattered in all manner of directions, making dancing patterns on the waves. It is truly a stunning sight. Some are huge, some are small, but all are beautiful. And what's interesting about icebergs is that most of it is actually hidden under the water. We only see a tiny portion. A vast quantity of solid immovable ice is what supports the amazing sight that you see. And the bigger the sight above the water, the bigger the base below.

I have just spent a month at home in England, partly working and partly vacation. I have loved seeing friends and family and I have been totally blown away by people's love and support. Many of you have bought me coffee, lunch, dinner, prayed for me, given financially, and generally encouraged me. I am surprised how many of you have said things like, 'we love your blog'; 'what you are doing is SO amazing'; 'we love hearing your stories of hope and healing and feeling connected'. I honestly hadn't expected such an overwhelming reaction. And the truth is ........I think I feel a bit like an iceberg.

I may be the tip of the iceberg, the one who is seen. But truly, you are all the base that supports me. That was so very evident to me this last month in England. So I wanted to say a huge thank you to everyone for supporting me emotionally, professionally, spiritually and financially. I am only who I am, and can only do what I do, because of all that people have sown into me over the years. Many people have helped to develop my character, my natural abilities and my skills as a doctor, to make this current work possible. The truth is I wouldn't be working for Mercy Ships without this base of support beneath me. When the base of the iceberg melts, the tip disappears. So, sincerely, thank you for being the hidden base that gives beauty and form to the tip.

Another thing that struck me this month when people repeatedly said to me, 'you're doing amazing things', is that actually we are all doing 'amazing things'. We just have to realise it.. My medical colleagues do an amazing job caring for some of the sickest children in England; parents and grandparents do an amazing job investing in the next generation. Even simply having a coffee, a round of golf or a game of tennis with someone can also be amazing if you use that time to speak words of comfort, hope or encouragement. Helping someone by doing their shopping, cooking a meal, visiting them in hospital is pretty amazing too. Why?  Because these things all bring life and hope to others...... and that is good news for those who receive it...that's why it's amazing.

So thank you for being part of my iceberg....for keeping me afloat (and not melting in the heat) so that light can glance off me bringing beauty, dignity, hope and healing to the poor of West Africa.
And I hope you can see your potential as an iceberg too....bringing beauty, dignity and life to those around you.

Josephine and Chara …..inspiration for a vision

I often think about Josephine and Chara. They were both been patients of mine who needed complex surgery.  Complex surgery often requires complex anaesthesia.

Sierra Leone, May 2011: 2 year old Josephine chokes on a stone and it becomes stuck in her lung. There is one surgeon in Sierra Leone who thinks he can help, but there isn’t an anaesthetist capable of anaesthetising her. Mercy Ships and I agree to help. Unfortunately the surgeon can’t remove the stone, so Josephine is left fighting for her life in the intensive care unit on the ship. She needs a specialist lung surgeon but Sierra Leone has none. There is a surgeon in Ghana but, no paediatric anaesthetist for lung surgery. The nearest place would be South Africa, and it would cost over £250,000 ($400,000). So, we flew a surgeon from Kenya to the ship and Josephine made a miraculous recovery.

I thank God that when Josephine needed help, Mercy Ships and I could provide the specialist help .  

Togo, May 2012: 1 year old Chara has Crouzon’s syndrome and needs specialist surgery to adjust the bones of her face and skull. Her bones have developed abnormally and without surgery Chara could become brain damaged and blind. A German craniofacial surgeon came to the ship to perform the major surgery Chara needed. Initially she recovered well but then developed complications of infection and leakage of fluid that surrounds the brain (CSF).  These were difficult to treat and delayed her discharge which was critical because the ship was leaving Togo in June. Chara had to be discharged to a local hospital and she subsequently needed further surgery. But no anaesthetist was prepared to anaesthetise her, and even the neurosurgeon was reluctant to operate on such a small child. So, Chara will be transferred to Germany to complete her treatment.

I used to work in a large university hospital with specialist paediatric services. Children received whatever they needed. Sadly that is not true for most children in Africa, for whom health services are often woefully inadequate. In particular, there is a shortage of surgeons.

Imagine….    England with only 200 surgeons. We would have the same access to surgery as the average African.

Imagine….     England with only 25 surgeons. We would be better off than the average rural African. And the average rural African would have to travel hundreds of miles to see the surgeon and PAY for the initial consultation and surgery. Earning less than $200 per year, they would never afford the cost.

10% of all adult deaths in Africa are due to lack of access to surgery, and 20% of all child deaths.

Furthermore, most anaesthetists in Africa are not doctors. They have done a 3 year technician course and actually do a tremendous job in very difficult circumstances and for very little reward. However, most have inadequate training in paediatrics, so cannot anaesthetise children for complex or life-saving surgery. In Togo, I estimate there were only 2 medically qualified anaesthetists.

Josephine was lucky, but Chara was not so lucky. Chara needs to travel to Germany to complete her treatment because we had to leave. I’d like to see ‘luck’ become unnecessary. I’d like to see at least one specially trained children’s anaesthetist in each African country.  

Too big a vision?               May be.

Is it possible?                     I hope so.

Will I see it happen in my lifetime?           Probably not.

But does that deter me?              No.

I believe we all need a vision, and we all need hope. Hope that will outlast our lifetime. Without vision and hope I don’t think we ever achieve very much. Many great achievements in history took a lifetime to complete, and many were finished after their champion died. William Wilberforce and the abolition of slavery is a great example. And I highly commend the film Amazing Grace to anyone who has not seen it. It is one of my favourite films.

I have a vision – to train anaesthetists to help children like Josephine and Chara.

I have a hope - healthcare in Africa can be transformed.

What is your vision, what is your hope?

Mercy Ships is involved in training surgeons, anaesthetists and nursing staff. We work with the Ministry of Health and the Ministry of Foreign Affairs in the countries we visit, to identify the needs and how we can help. Thank you for reading this and supporting the work we do.