How do we find our patients?

I am often asked the question – ‘how do you find your patients?’

Answer: Teamwork and Communication

In days gone by we held a mass screening at the beginning of the field service. Literally 1000’s of patients would turn up, sometimes 7000 in a day. It took all the crew to organize safety lines of patients, to escort them from room to room through the process from: basic assessment, to a registration station for name and contact details, basic medical of blood pressure and heart rate, a surgeon assessment, a biopsy or ultrasound, photographic documentation, and finally a scheduling appointment station etc. We worked closely with local police to ensure crowd management was safe and calm and we would use a very large venue such as a football stadium to host the day. This would yield most of our patinets for the 10 month field service. Problem was, most of our patients came from nearby. Or even if not, the country was relatively small and you could reach even rural areas in 9 hours on a bus. This model worked well in countries where the port city was the capital (or major) city, and there was large scale urbanization. This is the case in many West African nations.

However, Mercy Ships is expanding, last year it was Central Africa (Republic  of Congo) and now it is East Africa (Madagascar). And so our strategy has expanded and adapted to take account of the differences. Namely larger countries, with less urbanization.

In the last few years we have been pioneering a new approach – going to where the patients are instead of expecting them to travel to us. The aim is two fold – first: to really reach the poorest of the poor, those in rural areas with no access to healthcare; secondly: to reduce needless travel for those who we know we cannot help and to prevent patients waiting all day in a line of 1000’s of people, only to be told ‘no, I am sorry we cannot help you’. Most healthcare aid/development work takes place within a 100km radius of the capital or major port city. We are trying to reach beyond this and go out further and deeper to the areas of greatest need.

We have a dedicated team of 4 screening nurses who travel the country and assess patient’s suitability for surgery. Those who fulfill our criteria are given an appointment card to come to the ship to be seen by the surgeon on the dockside. We call this surgeon screening. If the surgeon agrees to operate the patient is given a date for surgery. We have proven nurses can screen very accurately and 80-90% of patients they bring to the surgeon screenings are accepted for surgery. But they can’t do it alone. Madagascar, in particular is a huge country. So, while the screening team have literally travelled 1000’s of km, (see red triangles on the map) they have been helped by a number of people:

·         Mission Aviation Fellowship – have flown them to remote areas

·         Many partners, other mission organisations, charities, large and small businesses, telecommunications companies here have spread the word and communicated via radio, TV, posters, SMS (text messaging)

·         Our own Communications department have designed posters, written and translated the radio broadcasts and other advertising material, and set up a FaceBook campaign (FB is big in Madagascar)

·         Senior management have helped craft the overall strategy and trusted those below them to carry out a very successful campaign.

A dedicated team of highly skilled nurses can only achieve so much, teamwork and communication can achieve so much more. Reminds me of the WHO Safe Surgical Checklist, a surgeon can only achieve so much, but teamwork and good communication can reduce mortality and complications by up to 50%.

Gifts - thank you

Three years ago I resigned from my consultant job in Paediatric Cardiac Anaesthesia and Paediatric Intensive Care to work full time for Mercy Ships. And what an incredible journey these last 3 years have been, emotionally, professionally and spiritually. And it is not a journey I have travelled entirely alone. It feels like many of you have travelled with me through a kaleidoscope of different contributions. So it is a shared journey because your help makes it possible.

Emotionally, living without a salary is a strange phenomena in today's world and I have found the experience very humbling. Clearly it is impossible to raise your own living costs, but with the support of family, friends, organisations and other charitable donations who give in many ways it has been possible. And over the last three years I have been frequently moved to tears and humbled by people's gifts. A friend of mine recently wrote a blog about gifts and she quoted this definition:
Gift [gift] noun
1. Something given voluntarily without payment in return, as to show favor toward someone, honor an occasion, or make a gesture of assistance; present.
2. Something bestowed or acquired without any particular effort by the recipient or without its being earned.

Often people's gifts have come at just the right time, when I am struggling, or wondering how something will work out, or simply feel exhausted and in need of encouragement. The gifts don't have to be large or even financial, sometimes a simple cup of tea or glass of wine, a short chat, has lifted my spirits in ways some of you wouldn't even know. A timely email has the same effect. I thank you as friends for every gift, large or small you have given.

Professionally, many medical colleagues of mine have also given me additional gifts. Gifts of encouragement, good advice, and metaphorically speaking, you have held my hand part of the way. We have shared the joys and the trials of teaching and training in low income settings, we have wrestled with the difficulties and tried to make a difference. You have stretched me and introduced me to people who have challenged and shaped my thinking. And you continue to support me, and encourage me to think about the future and the inevitable question, ‘what will I do next?’

Spiritually, my faith in God who can provide and who can do the impossible has grown beyond measure. I have seen God provide for my needs, financially, emotionally ,and I have witnessed many miracles in the wards of our hospital. Translators who couldn't speak a local dialect being able to speak it to a certain patient who needed it but not to others, a lady with a vesicovaginal fistula which was not amenable to surgery was prayed for and her ‘leaking’ stopped, someone else who was HIV positive was prayed for and then said to be HIV negative, several intensive care patients have gone from being medically speaking ‘at deaths door’ to suddenly extubated (off all life support machines) and back on the ward in less than 24 hours – phenomena I have never seen before. Also, individual crew members coming to the ship have seen their own lives transformed through prayer and encounters with the love and power of God. Not to mention, the God-inspired ideas that I feel I have had. Ideas that have defined the creation and the current strategy of our healthcare education program. The favour we have had with contacts at home and abroad. I see Gods’ hand at work everywhere and I am grateful for your gifts – your prayers that open doors in the heavenly places and afford protection and strength to continue.

But it hasn't all been easy. I can't say I have loved every minute of it. There have been tough times. I miss family and friends, I miss playing golf, sailing, simply walking down the street alone and sitting in a café, I even miss running in the cold and rain. Living and working in a small community isn't always easy either, relationships are easily strained and life can feel very intense.  I shared a room with two others for two years, but now have my own room which makes huge difference, but others I work with and rely upon are not so fortunate.

However, as a Christian, I believe that since God has called me to work with Mercy Ships he will  provide whatever I need (physically, emotionally, spiritually, financially, professionally) because that is what the bible promises. And that truly, has been my story.  I have witnessed God provide through so many of you in a miriad of various gifts. Gifts….those things, ‘given voluntarily without payment in return, as to show favor toward someone, honor an occasion, or make a gesture of assistance; bestowed or acquired without any particular effort by the recipient or without its being earned’.

Whether you believe it or not, The bible says we are all made in God’s image, so it doesn't much matter what you believe, you, each of you do in fact exhibit parts of God’s character  - generous gift giving for one. I know – I have seen it and experienced it from you.

Thank you from the bottom of my heart, and I wish you a very Happy New Year, and may God bless you more than you expect or deserve.

Christmas - An event for everyone

This is how Christmas seemed to the shepherd:

There were sheepherders camping in the neighbourhood. They had set night watches over their sheep. Suddenly, God's angel stood among them and God's glory blazed around them. They were terrified. The angel said, "Don't be afraid. I'm here to announce a great and joyful event that is meant for everybody, worldwide: A Saviour has just been born in David's town, a Saviour who is Messiah and Master. This is what you're to look for: a baby wrapped in a blanket and lying in a manger. (Luke 2:8-12 )

'God's angel stood among them and God's glory blazed around them'. Every Tuesday morning at 7.30 we gather in the operating room corridor for 20 minutes / half an hour of devotions. This is a time where we sing some songs of worship and then focus our attention on God, his character and his love for us. It is a bit like a longer version BBC Radio 4 'thought for the day'. Every week, the discipline of doing this and committing ourselves to God really moves me. 30-40 beautiful people from all around the world, working in our hospital, all volunteering to serve those less fortunate than themselves. Many of these folks have given sacrificially to come, and have left their own families behind to be a part of our ship family for a few weeks. The other week as I looked at our group I think I saw an angel. Actually I think I saw more than one. As I looked at our group of people, I saw hearts shining, overflowing with love, literally radiating the love of God. Some were burning brighter than others, not because they were actually brighter but because the others seemed covered somehow.....so their light couldn't shine. But as I continued to worship and praise God, I saw the covers being lifted off, it was as if somehow the sound of our praises caused the covers to be removed allowing the lights in their hearts to shine. And I was reminded of this passage of scripture, God's angel stood among them and God's glory blazed around them, and I wondered if God's angel was indeed among us, and glory blazing around us. Blazing with such intensity that we were literally transformed by it, so that his presence in us made our hearts shine. No matter who we were, or what we had done, or not done, his glory transforms us. He saves us from the things that cover us and continue to drag us down. He saves us to make us beautiful and radiant. It was a great and joyful moment to catch a glimpse of the treasure inside each person, even if was buried deep within and covered.....it could be uncovered.

And that is what Christmas is all about. 'A great and joyful event that is meant for everybody, worldwide'. It is a free gift for everyone, regardless of race or religion or wealth or status. The gift of a saviour.......and not just to save us from our sins......Oh no, no, no.......there is so much more to the Christmas story than that. I am talking about something more tangible, more credible. The gift of a saviour to save us from whatever we actually need saving from. Think about it: Matthew was a tax collector and he was greedy for wealth and status, Jesus saved him from that desire 'to have and accumulate' and gave him freedom to give and be generous. Mary was a prostitute, trapped in a situation she probably didn't chose for herself and didn't want to be involved in but circumstances had forced her into. Jesus saved her from the guilt and shame, and gave her freedom to be a women allowed back into society again. Lepers were excluded from society, considered less than human and with no hope of healing. Jesus healed them and gave them back the right to be considered human.

A saviour has just been born and the shepherds were told, 'this is what you are to look for, a baby wrapped in a blanket lying in a manger'. This phrase makes me wonder, what saviour has just been born in your town, close by, waiting to save you? What do you need respite from this Christmas? For the shepherds they didn't exactly expect their saviour to be a baby in a manger.......so as you look for your saviour this Christmas, be ready for the unexpected, be open minded, and let God meet you with his angels and show you his love in the form of his son, your saviour who can rescue you from whatever is troubling you this Christmas time. For the shepherds, salvation was in the form of a baby wrapped in a blanket lying in a manger, I wonder, what unexpected form will your salvation take this Christmas time?

I pray you will see his angels appear to you and his glory blazing around you and you will find the Saviour you are looking for.
Happy Christmas and peace to you.