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.