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.

Goodbye: ‘It breaks my heart’ …or does it?

We are packing up in Togo. This field service is over and we are preparing to go to Guinea. What legacy have we left behind? What impact have the people of Togo left on our hearts? As many crew members depart, and less than half of us are left onboard for the sail, I have witnessed many tearful goodbyes.  Many times I have heard the phrase ‘It breaks my heart’. Indeed, I have said it myself.

But is it actually true? Does it really ‘break my heart’ when I say goodbye? Or is it more that my heart is so full, it is simply overflowing.  

Imagine your heart is like a cup full of orange juice. If the cup is cracked or broken, the orange juice spills out. It makes a mess, and my hands get sticky. It the cup contained hot tea, my hands would be burnt and it would hurt. The same would happen if the cup wasn’t broken and I just kept pouring the orange juice in. It would overflow and run down the sides and make a mess, the hot tea would spill over and burn my hands. A broken cup and an overflowing cup can look the same. But the difference is, the broken cup ends up empty, the overflowing cup stays full.

It is the same with my heart. That is why I am growing to dislike the phrase, ‘It breaks my heart’.  I prefer to say, ‘My heart is overflowing’, because I believe that is the truth. When I say goodbye to someone I love, it hurts because I grieve the loss of their physical presence in my life. But my life is still richer, my heart fuller because I met them. I am thankful for the blessing they have been to me and the times we have shared together. Saying goodbye does not and should not ‘break my heart’.

And as a follower of Christ, I remember the promises of God which are:

I am with you always; I have loved you with an everlasting love; I have plans for you, plans to prosper you and not to harm you.

Then the question is, do I believe what God says? It is either true or false? There is no middle ground. No option to think ‘sometimes God’s with me, sometimes He’s not’ or ‘I know he has plans for me, but maybe they aren’t that good  because he doesn’t really  love me’. Little seeds of doubt can so easily creep in, eroding our confidence in God’s word, and ultimately our faith and trust in Him.

So for me, when I say goodbye, I chose to trust what God says is true. He loves me and is with me always.  And God also loves the person I will miss. He is with them always too, and He goes with them in ways I cannot possibly go. I don’t want to cling onto them any more than I want them to cling onto me. I want to be the woman who walks out the plans and purposes God has for me, even if that means leaving and walking away. And I want to release my friends to do the same. When they leave, I want to say goodbye and send them off, releasing them into Gods hands, to fulfil the plans and purposes God has designed for them.

Why is this important? Well it is all about speaking and believing truth versus lies. I believe we need to fight for truth. Why confess a lie, when you can confess truth. More on that another time. Meanwhile, as I say my goodbyes, I am not going to say ‘It breaks my heart’, because I don’t think it is true. The truth is my heart is overflowing and richer and fuller because I have known you. And I release you to go with God, in the knowledge of his love and to walk into all the plans he has for you.   

Fati's story....obstetric fistula surgery

Fati’s story

Fati has 4 children. All were born without any problems, but her fifth child was different. He got stuck. Slowly, painfully, she laboured for 4 days. Her husband found someone to help take her to the nearest hospital, several hours drive from their village. But the hospital turned them away. Fati and her husband did not have the money to pay for the caesarean section she needed. They tried another hospital, and another. But each time the story was the same. No money, no treatment. They became desperate so they lied. They told the fourth hospital they could pay for a caesarean section and so Fati was admitted. Her baby had long since died, but at least her suffering was over, or so she thought. She and her husband sneaked out of the hospital the very next morning before it was light. They ran away because they couldn’t pay. Fati noticed the wetness immediately, but she thought it would heal up as her body recovered from the ordeal. But it persisted. The wetness made her skin sore, but worse, a stench of stale urine became her constant companion. It was overpowering. Her husband left her and people in the village shunned her. She became an outcast, and relying on people’s pity and scraps of food thrown to her, like dog. Her life had changed beyond anything she could imagine. She existed, but wished she didn’t. She had no hope. Fati contemplated suicide. Fati has a vesicovaginal fistula (VVF).

Obstetric Fistula – medical details

A fistula is a hole, or abnormal connection between two structures. Obstetric fistulas (of which VVF is one type), are caused by obstructed labour and lack of access to obstetric care In obstructed labour the fetal head causes unrelenting pressure on the pelvic structures, damaging them severely. The bladder, urethra, vagina, uterus and rectum can all be damaged. The tragedy is that obstetric fistulas are totally preventable by access to appropriate obstetric care, which is why we don’t see or hear of them in the ‘west’. Moreover, there are few ‘western’ surgeons who specialise fistula surgery because there is minimal need.  But here in Africa, among the poorest of the poor, the need is great indeed.

Mercy Ships

I have just spent the last month working with Dr Lauri Romanzi, a fistula surgeon from the US. We have performed just under 50 fistula repairs, and trained a Togolese surgeon, Dr Sewa in both spinal anaesthesia and repair of simple VVF’s. Some of the fistulas we encountered were complex, difficult cases and we worked late into the evening many times to help all the women who were scheduled for treatment. Women with fistula suffer from a huge loss of dignity and self-worth. One of the wonderful things about fistula surgery onboard the Africa Mercy is that it doesn’t just treat the body but also the soul. The women receive a new dress and gifts when they are discharged which signify a restoration of dignity, identity, significance and self-worth. This is a time of celebration. There is dancing and many women share their stories. It is a moving occasion and we call it the ‘Dress Ceremony’.

Togo, Niger, and Ethiopia

Togo has recently made caesarean sections free of charge to all women. That is a huge step forwards in fistula prevention. The next step is to train more surgeons / medical officers /anaesthetists to perform spinal anesthesia and caesarean section, and improve access to these facilities. In the meantime, we will continue to train doctors like Dr Sewa to help his people and we will continue to need facilities like Danja Fistula Centre in Niger.

Danja Fistula Centre in Niger is a fistula hospital which officially opened earlier this year. It was built and is partially funded by The Worldwide Fistula Fund. A friend of mine, Sarah Walker, who used to be nurse on Mercy Ships, now helps run the hospital. They are short of anaesthetists. So anyone wanting to help for a few weeks to a few months would be most welcome.

One of the biggest Fistula hospitals in in Addis Ababa, Ethiopia. A fascinating history of this hospital, and more insight into the lives of women suffering from VVF is given in the book, ‘A hospital by the river’ by Dr Catherine Hamlin. Dr Hamlin has been describe as a ‘modern Mother Teresa’.

You and me
How will you be described?
How do you want to be described?