Hospital Hierachy....the poorest of the poor

I have been thinking a lot about training and education.  As a hospital ship we aim to provide surgical health care to the host countries we visit, but we also try and provide education and training for doctors and nurses. However, this is not as easy as it sounds, it is an area we are developing, and it has got me thinking.

Mercy Ships has been in Guinea for 6 weeks. In that time we have set up our hospital and have received over 50 different requests for training, from various sources. We are managing these according to (i) what falls within our areas of expertise; (ii) assessment against predetermined criteria;  (iii) and finally, because of our own limited resources, what we consider a priority.

Interesting that last point…..what we consider a priority……what do you think? Who would you prioritise for training in a surgical hospital?

         i.            Surgeons

       ii.            Anesthetists (doctors or nurses)

      iii.            Nurses

     iv.            Lab technicians for diagnosing with blood tests

       v.            Xray /ultrasound technicians / radiologists for diagnosing using imaging

     vi.            Sterile Processing technicians who clean the surgical instruments

Until last week, I think I would have focussed on the doctors and nurses? Maybe that’s because I am a doctor? But I met someone a few weeks ago who has changed my focus.

Christina is a Canadian who works in Sterile Processing. She is also an instructor for the International Standard qualification. But more than this, she has an incredible passion to help West African hospitals improve their hygiene standards and to take ‘sterility’ seriously. Spending time with her has been enlightening.

I drove Christina to the 3 main hospitals in Conakry, the capital of Guinea. One hospital did not even have soap and water to wash your hands with. Another used laundry detergent to clean the surgical instruments after an operation. There were no brushes to clean the instruments, so they cleaned them with rags or bare hands. There was no disinfectant, let alone any functioning sterilisation equipment of any sort. Dirty instruments were kept close to the ‘clean’ ones, the walls and floors were filthy and there was clutter everywhere. Many of the surgical instruments were rusty. Totally the opposite of what would be described as ‘best practice’. Christina, spent time with the workers and then spent 2 weeks literally ‘rolling her sleeves up’. She helped clean the floors and walls, gave the workers gloves and brushes to clean with, and educated them in simple practices to improve the hospital hygiene.

What amazes me is that the people who act as sterile processing technicians in Guinea, have no training; they are given no gloves to wear even for handling hot steamers so many have burns; and furthermore they are not even paid! They hang around all day, hoping an operation may happen (only if the patient can afford to by the necessary supplies such as drugs, cannula’s and fluid) and then hoping that the surgeon will ask them to clean his instruments afterwards. Then the workers wait to the end of the week and hope the surgeon will give them some money for their efforts, but the surgeon is not obligated to do so. They literally wait around for work, and then have to depend on the goodwill of the surgeon in order to feed their family.

Mercy Ships aims to help the poorest of the poor, by working in West Africa. It struck me that Christina, is also working with the poorest of the poor amoungst the hospital hierarchy. Sterile Processing technicians tend to be the forgotten ones, even in hospitals in England.

My time with Christina has made me think. I can train a surgeon or an anaesthetist, but if the instruments are still dirty how much will it ultimately achieve? As a medical student many years ago in Zimbabwe, I vividly remember a missionary surgeon taking me to a lady whose hip fracture he had expertly fixed. But now she lay dying of sepsis, from bed sores due to poor nursing care, and also no doubt inadequate sterile practice. A doctor can be expertly trained but without the support of his team, he will never reach his full potential.

Training doctors in Africa sounds glamorous, training Sterilisers doesn’t.  But I am not interested in glamour. Neither was Jesus. He rolled up his sleeves, got down on his hands and knees and washed his disciple’s feet. Reminds me of Christina, cleaning the operating rooms in Guinea on her hands and knees. Giving value to a profession that is undervalued. Making a difference.  From now on sterile processing will be part of our medical training initiatives in West Africa because it seems to me, that the poorest of the poor in the hospital heirachy, have been forgotten for far too long.

Thank you Christina for what you taught me these last few weeks & good luck with setting up your charity / NGO: Sterile Processing Education in Developing Countries……or whatever name you decide upon. May God bless your endeavours and make all you do succeed.

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.