Hope for Africa

Many young people in Africa want to leave and live in other countries to make 'better life for themselves'. Why? Because they believe Africa has no hope. They feel there is not enough food, not enough water, that Africa is over populated, and there is no hope for them if they remain here. Yet, this belief, is built on ignorance and lies.

In truth, Africa is least populated continent; Zimbabwe, Zambia and DRC have the potential to feed whole of Africa, there are great rivers in Africa for water and Africa has 40% of the world's hydro electric power potential. Every single African nation has mineral wealth and many coastal nations also have oil wealth. Africa is a beautiful rich and abundant continent. Yet many people (African or not) do not know this.

I learnt some of these facts from Chris Ampadu. We have just finished running a Medical Leadership course in Pointe Noire, where Chris and I shared the speaking. Chris is from Ghana and has run leaderships conferences for Mercy Ships for 7 years training government, community and church leaders. He works for Samaritan Strategy.

How can Africa, which is the richest continent in terms of natural resources, be also the poorest continent?

Because many people in Africa do not believe the truth. Many have a mindset of hopelessness. A worldview that is actually built on ignorance and lies, thinking Africa is cursed, but in fact, Africa is blessed. Blessed with abundant natural wealth and resources.

Apparently between 1980-1988 sub-Saharan Africa received $83 billion, and yet loving standards declined by 1.2% a year and the GDP (in per capita terms) declined 2% in 1986 and 2.2% in 1988. From 1990-2003 the region averaged $20.4 billion per year in foreign aid, yet the GDP was lower in 2002 than 1980. Africa has attracted more aid per capita than any other region, and yet it remains poor. Africa has rightly rejected colonialism, yet has not yet moved into embracing her independence. Instead, she continues to rely on western aid.  Needing external money for development instead of using her own resources. Chris encouraged Africans not to see themselves as beggars. But as people with dignity and resources. To move away from the 'poverty mindset'.

Chris asked another question, When major life events happen such as death to young people, how do people in your culture explain these things?

For many African's the answer is 'Witches'. When bad things happen the first question people ask is 'who did this to you?'  

What are the consequences of this? Eg when you as a doctor make a mistake, what will people think, how will they interpret it? 'It is not your fault, it was a witch / curse'. So if people don't hold you responsible where is the motivation to improve? Doctors don't worry they will be taken to court. Witches are blamed instead, which could be rather convenient.

Beliefs ....lead to.......values......which lead to.....behaviours.....and then.......consequences

We also discussed cultural attitudes to time, women, corruption, reliance on external aid and 'the white man'. Lies such as 'corruption is normal', and it doesn't matter if you are late for work. This is why there is poverty. This is why life feels hopeless. Yet only the people themselves and their leaders can change these things.

In discussion groups the medical leaders discussed cultural lies in the domain of medicine and what impact these had. Changing these mindsets is difficult. But if we are serious about improving quality of care and patient safety doctors need the humility to admit their mistakes and short-comings, and courage to initiate change. We know on medicine that Quality Improvement is a combination of leadership and process, not just better training  and technology. But for medical leaders here to feel empowered to lead well and initiate good processes in their hospital their need to understand their own worldview and the pervaded worldview of those they work with. Otherwise they will not be able to initiate lasting change.

The conference consisted of three days. The first day was all about exposing cultural lies. The second day, the 'soft' side of medical leadership, the 'heart' side of the head, heart, hands voice concept, otherwise known as the 4 'T's of leadership: truth, trust, teamwork and training. Chris brought the African side and I brought the western medical perspective. On the final day we spent a lot of time talking about one of my favourite topics, the World Health Organisation Safe Surgical Checklist. This is an example of good process which requires leadership, communication and teamwork to successfully and sustainably be implemented in Africa. No country in Africa has managed this yet. Perhaps the Republic of Congo could be first. They certainly have the potential to be. Only time will tell. I pray that these few days have sown some seeds. I leave you with an African proverb I learnt this week

'You can count the seeds in a mango, but you can't count the mangos in a seed'

It was a pleasure to work with Chris Ampadu and the rest of the team, Krissy, Stella and Francis. Thanks for all your hard work.

Perspective

When you sail into Pointe Noire, Republic of Congo, you sail past many many oil platforms. And as you get closer to the shore you see many ships, specially designed for helicopters to land on, with helipads mounted over the bow. These ships help get workers on and off the oil platforms. Once inside the the protected walls of the port, the 'oil' presence gives way to the usual vast array of container ships. This is a very busy port, so ship after ship is lined up, and on shore, huge areas containing hundreds or thousands of twenty foot containers are clearly visible. These container ships along with a multitude of tug boats and pilot boats form the view out of my window, or should I says windows. Yes, I am lucky to have a cabin with more than one window. At least I do temporarily, because I am cabin sitting for a family who are away so I get to see this busy port scene every morning I wake up. But I used to live in a windowless 6x5 foot space for over a year. Then I was upgraded to a space with a few extra feet and a small window that overlooked the admissions tent on the dock in front of a large concrete wall. Three, over thirty somethings, sharing a cabin (smaller than the bedroom I used to have all to myself back home in England). However, now I have a family cabin on the other side of the ship, so instead of the dock I get to watch container ships being loaded and unloaded, tug boats gently nudging lager vessels in the right direction, fishing boats bringing in their catches. All the comings and goings of a busy port can be viewed from the spacious couch in my new living quarters. It is amazing how it has changed my perspective. If all I had seen was the sail into port, I would have described this place in 'oil' terms. From the other side of the ship I saw patients come and go and I had a hospital perspective. My current cabin gives a proper port perspective. My windowless cabin-space gave no perspective at all, it was dark and I needed artificial light to do anything at all. It felt like I could have been anywhere in the world.......except that not many people, even in prison, live in a windowless cell. But that is another other story and windowless cells are not my point! My point is perspective. Perspective is just that. Perspective. It is not reality. Perspective may affect how we feel about reality but it does not define reality. Whether I can see the oil rigs or not, whether I see the container ships or not, whether I see the patients coming and going from the admissions tent or not, none of that changes the fact that they are there and part of my reality. Even the gloom and dark of the windowless cabin does not negate the reality, even if it feels suffocating and overwhelming. We need to fight for the right perspective. Why? Because it helps us deal better with reality. Recently I have read a few people's blogs, witnessed a few incidents and had a couple of conversations with people. Some of them are struggling. Life is hard sometimes. That is why we need the right perspective. When we feel like we are suffocating in a windowless, dark place, we need to fight for the correct perspective. The biblical perspective which is reality. The reality that God called us here, and He is for us. He loves us and has promised never to leave us or forsake us. He calls us 'overcomers'. It is the enemy who tries to make us think from the perspective that it is all too tough, that maybe we misheard God, maybe we aren't really cut out for this life. Rejection, loneliness, insignificance, fear ......all such thoughts can come pressing in and alter our perspective. And when we are too tired to fight, or too crushed, we need our friends to fight for us and encourage us to get our perspective right. Reality is truth. Right perspective is also truth. But the wrong perspective, or a distorted perspective, or merely only half the perspective....none of these are entirely true. And if they are not truth then they are deception. Lies. I love my new cabin, the new perspective and the feeling of space. In the same way, I love the biblical perspective. The biblical perspective on life gives me hope because it gives me the truth. And the truth gives me power to overcome the lies, deceptions and half-truths that creep around and get me down. My cabin perspective is only temporary, thankfully true biblical perspective is eternal.

Intersection

Last month I celebrated my birthday. That night the Africa Mercy sailed across the Equator at the point where it intersects the Prime Meridian. Point 00.

In the maritime world, sailing across this intersection makes you a “Royal Diamond Shellback.” If you simply cross the equator you are a ‘Shellback’ and if you cross the equator where it intersects the International Date Line you are an ‘Emerald Shellback’.

A few weeks ago on August 28^th, we undertook our biggest patient selection in the history of Mercy Ships. Selection day is a day mixed with intersections of a different kind. Hope and disappointment. 7,354 people queued up, and 4,236 made it through the gate. That means 3,118 were turned away by the crew who walked the line. That’s a lot of hopes dashed. A lot of people leaving disappointed. People with conditions we obviously couldn’t help such as adults with abdominal problems, children with cerebral palsy or epilepsy. But for the 4,236 who came through the gate, hope was maintained. They waited patiently to get through the gate. Once through the gate they were met by one of a team of experienced nurses. After listening to the problem, the same answer was repeated many times, ‘I am so sorry we cannot help you’. Selection Day is one of the hardest of the year.

More people are turned way than are accepted for surgery. It is the harsh reality. The need is always overwhelming and we are only a surgical hospital ship. We do not have the skills or resources to help everyone. And even if we did, medicine also has limitations. For the nurses who have to say ‘no’ literally thousands of times, selection day is long and emotionally draining. But for every ‘yes, we might be able to help you, come on in and see the doctor’ ……the hope and expectation in palpable.

At 9.30 am I received an emergency call to the gate to see a child with breathing difficulties. The child was semi-conscious and gasping for breath in a distressed stated. Despite his dark skin I could clearly see he looked blue from lack of oxygen. I thought we could not help him. There could be many reasons for his semi-conscious state, cerebral malaria being one or some other infection that could depress his conscious level and cause him difficulty breathing. We cannot treat medical problems such as these and there was nothing to see externally. I tried to explain this to his parents but they indicated he had a problem inside his mouth. On peering inside I saw a huge mass, the size of a golf ball, completely obstructing his airway. No wonder 2 year old Noah could not breath. We fast tracked Noah to the maxillo-facial surgeon and scheduled him to be admitted as soon as our hospital opened. Exactly one week later we operated on him to remove the tumour. He is now doing fine on the wards and his mother hugs me every time I walk by.

Noah is in bed 1. Hope given at selection day has now materialised. His mother has heard him say ‘mama, mama’ again. Words Noah hadn’t been able to say for months. Words his mother thought she would never hear again. But even here on the ward, the intersection of hope and disappointment is palpable. Little Esther-Michelle lies in bed 15. Actually she isn’t lying, she is sitting up because every time she lies down she struggles to breathe. She is the same age as Noah. She and her mother had high hopes of help. And so did the missionary doctor who brought her to us. But we can’t help her. Esther-Michelle, like Noah, also has a tumour inside her mouth but for complex reasons we can’t help her. She and her mother are a picture of despair. Helpless disappointment is in their eyes. It is distressing to watch. Two other beds on the ward are also occupied by another child and a young adult. Both with inoperable malignant tumours. It has been a week of hope intersecting with disappointment and despair.

For me, I crossed the intersection of the equator with the prime meridian and became ‘royal diamond shellback’. In real terms that means nothing. But I like the phrase. It speaks of something special, something unique. Something to be treasured. So, as my medical world on the ship keeps intersecting hope with disappointment, I am calling each of these precious little ones ‘royal diamond shellbacks’. Despite their physical condition may they, and their parents, know they are unique and special, someone to be treasured till the day they die. Be that very soon or in many, many years. And as doctors and nurses caring for them, I pray we make that known in the way we treat and care for them when our medical skills have nothing more to offer.

And I pray it for us too. May we consider ourselves as, and treat each other like, special treasured royal diamond shellbacks.

(NB names have been changed to protect patient indentity)