Given.

What gifts are you wanting this Christmas?

Nothing is more precious than a wanted or deeply needed gift.

In my career as a paediatric anaesthetist and paediatric intensive care doctor, I have met many parents of critically ill children. Most parents would willingly give up their own life if it would save their child's life. The Christmas story is the other way around. A parent gives up the child's life. That is the extraordinary thing about Christmas. A child’s life is GIVEN for our benefit.

Jesus was born for us. His life is a gift to us. A much needed Christmas present. Let me explain why?

Isaiah 9:6 says,

For to us a child is born, to us a son is given, and the government will be on his shoulders, and He will be called Wonderful Counsellor, Mighty God, Everlasting Father, Prince of Peace

In this scripture, the writer is describing a vision he saw. He saw the darkness and gloom of a nation and he saw a child born who would remove the darkness, and bring hope. So we might not be ‘ruled by life’, but instead ‘rule in life’. That is the benefit of Jesus's birth.

I don't have to be 'ruled by life'. I don't have to be a victim of the stressors and pressures of my job, or the bad things that happen, like when children get sick, or when people bully me. Life can be brutal on hope, but I can learn how to triumph in these situations, to overcome and to 'rule in life'. It is possible to rule, even when life is hard. How do I know? Because i have experienced it and because the bible also says that 'He (God) prepares a table for us (ie a banquet, a feast) in the presence of our enemies'. Psalm 23 :5

So how does the birth of Jesus at Christmas make this possible?

1.    Because 'the government will be upon his shoulders'. Someone explained it like this, 'His government consists in ruling in the hearts of his people, in subduing their enemies, in protecting them, their persons and properties, rights and liberties, and in supplying them with everything necessary; and this government is delegated to him from his Father, is not of this world, but is spiritual; it is righteously administered, is peaceable, and will continue for ever'. Jesus was born to rule. And so are we, in his name.

2.    'And he will be called....'. In Hebrew, to be called and to be are the same thing. Names are important. They define who we are and what we carry. Look at who Jesus is and what he carries / comes to bring:

•  Wonderful Counsellor.

Jesus has wisdom and creative solutions, we just need to ask him. As Alan Scott says, 'there are answers in the heart of God that you cannot google'.

•  Mighty God.

Jesus is not just a sweet baby in a manger, but he is the Powerful and Mighty God. He has defeated all the schemes of the enemy.

•  Everlasting Father.

Protection, love, care, and everything you need or want a father to be, Jesus is and will be forever.

•  Prince of Peace.

Jesus is the Prince of Shalom, the Prince of Prosperity, the Giver of all Blessings.

May you know how to rule in life, because for you a child is born, for you son is given.

Happy Christmas

Africa is a continent not a country

Last month, October, I was teaching at an anesthetic meeting in Washington, DC. While I was there I attended several sessions relating to education and safety in Anesthesia. Some related to the use of simulation and checklists in western education; others related to teaching in low income settings. Most of these sessions were excellent, full of dedicated professional people, sharing ideas and desiring to see progress and equality for all in access to education and standards of healthcare that benefit all people everywhere. Much of it was hugely encouraging and inspiring.

There was also talk about standardising both training for the trainers so they were 'acreditted' before they taught overseas; as well as standardising what was taught ie the curriculum. While I unreservedly applaud these efforts, something in me is unsettled. I find myself wondering why people talk of Africa, or other 'low income countries' as all the same? Why do some people 'lump them all together under the same umbrella?' Africa, Asia, South America etc are vast continents with widely differing cultural values and expectations, resources and unmet needs. How can they, let-alone why would they, want to be treated the same? European countries have different standards of education and curricula, and these are different to the US and Canada; Australia and New Zealand etc. Standards are good, but 'standardisation' is not the same thing.

Furthermore, why should we in the West dictate what others need to learn? Western medicine has moved away from the paternalistic model of health care whereby the doctor tells the patient what is best for them and makes the decision. We now have an approach based on patient autonomy and informed choice. I find myself wondering if the doctors paternalistic approach is now manifesting in another format, dictating to Africa (or other low income countries) what they need and how they should be trained. Why not let Africa tell us how we can help?

It is easy to forget that Africa is a continent not a country. Africa is a huge place see the picture below. All the countries that make up the continent of Africa are vastly different, just like different European countries are different. I have spent time travelling in several countries in Southern African (including working in one) and have visited one country in North Africa.  With Mercy Ships I have worked in five West African countries, both the Francophone counties of Togo, Benin, and Guinea, as well as the English speaking ones of Liberia and Sierra Leone. Last month I made my first visit to Central Africa, visiting the Republic of Congo, otherwise known as Congo-Brazzaville to distinguish it from the Democratic Republic of Congo (DRC). Each one is very different. Yes, there is room to improve standards of healthcare, but I am not sure 'standardisation' is what is needed.

I was in Congo as part of a preparatory team for Mercy Ships visit in August 2013. We were doing some diplomatic and logistic work, as well as assessing their medical training needs in the areas where we have expertise, in order to see where we can best be of benefit. Mercy Ships has a lot of experience in West Africa, but one thing we were very aware of, was the culture in Central Africa is very different. Things which have not worked well in West African countries may indeed work well in Congo for a variety of reasons. The reverse is also true.

Mercy Ships and I, will need humility, courage and love to succeed in this new place. Humility to listen to what the Congolese tell us and accept when we get it wrong; courage to try different ways of working and change our existing practices where necessary; love for the people of Central Africa and especially Congo. Because if love is what motivates us, we will ultimately succeed, because 'love covers a multitude of sins'. Love overcomes the paternalistic attitude, the pride and boasting, and egotistical talk that says we know what is best.

"Love never gives up. Love cares more for others than for self. Love doesn't want what it doesn't have. Love doesn't strut, Doesn't have a swelled head, Doesn't force itself on others, Isn't always 'me first,' Doesn't fly off the handle, Doesn't keep score of the sins of others, Doesn't revel when others grovel, Takes pleasure in the flowering of truth, Puts up with anything, Trusts God always, Always looks for the best, Never looks back, But keeps going to the end." 1 Corinthians 13: 4-7 (Message version)

I want to help the countries where I serve to improve their standards not give them a standardised approach. I know I need humility, courage and love. And I think this probably applies not just to me in the continent of Africa, but to all our situations, wherever you are as you read this. Humility to admit our mistakes, courage to break new ground and overcome adversity, and loves that keeps going to the end.

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.