Grace

This month story is written by Catherine Murphy one of the ship writers, and I have added a few medical details and personal reflections at the very end. I have chosen this story because it typifies why I do what I do and have chosen to serve with Mercy Ships. Grace was one of our first patients up the gangway in Congo. On September 10th, we removed the massive tumor from her face. It’s been several weeks since her surgery, but 17-year-old Grace is as sassy as ever – and she’s looking like a whole new young woman. “God is good because He did a big thing for me. I did not believe that I could be saved, but God has had grace. Mercy Ships arrived in Pointe Noire, they treated me, and I am better today,” Grace says. Grace’s journey to the Africa Mercy began with an email. A hospital chaplain from neighboring Democratic Republic of the Congo met Grace at a hospital there. The chaplain, Pastor Gregoire, was shocked by Grace’s facial tumor, which weighed 4.9 pounds (2.2 kilos.) Pastor Gregoire came alongside Grace, counseling and praying with her. He says she was often so distraught that she cried all night. Sometimes she refused to eat or drink. “Indeed, she suffered,” he says simply. Pastor Gregoire took a photo of Grace and published it on his blog. A reader responded to his post, recommending that he visit mercyships.org, an organization that might be able to help. From there, Pastor Gregoire contacted the Mercy Ships Swiss office and exchanged emails with Christophe Baer. Through Christophe, Pastor Gregoire sent Grace’s medical records and reports to the Africa Mercy. The response was positive. Grace and Pastor Gregoire were asked to arrive in Pointe Noire, in the Republic of Congo, on September 2nd. Grace’s story is a chain of mercy forged by compassionate hearts, and their efforts were rewarded. She has been recovering in the Mercy Ships Hospital Out Patient Extension Center (HOPE Center), where she has become the champion UNO player. As Mercy Ships nurses will tell you, Grace dominates every hand – and don’t even think about challenging her to Jenga! Grace’s tumour was involving her jaw bone, so the first surgery (hemimandibulectomy) removed the tumour and replaced the jaw bone with a metal titanium plate. Three months later the second stage of the surgery takes some bone from the hip and puts it around the metal plate. The bone they grafts onto the metal and gives the jaw back it’s shape. This procedure is called an ‘iliac crest bone graft’. It is done three months after the original surgery to allow the mouth wounds to heal and to reduce the chances of infection in the new bone graft. Grace had this procedure (her second operation) just before Christmas. And she is recovering well on the ward and always says ‘hello Dr Michelle’ whenever I walk by. She is a very happy lady who brings joy and hope to the ward and the other patients. Near Grace’s bed lies, Angelique. Angelique is 22 years old and has a large tumor, rather like Grace, but Angelique’s tumour is coming from her cheek bone (maxilla) instead of the jaw bone (manidible). In a few days we will operate on Angelique and Grace will be discharged. This is why we are here. This is what I have spent the last two years doing. Someone once said, ‘transformed people, transform nations’. In another month, Grace will return home and begin school. She wants to be a nurse. May she go on to do that and transform many others people’s lives through what she does.

Contrasts

I have just spent two weeks in the Democratic Republic of Congo (DRC), which is the poorest country on earth, according to the United Nations Health Development Index (UN HDI). I was visiting the capital city Kinshasa and the port city of Matadi as part of a Mercy Ships Assessment Team. We were invited by the Ministry of Health to (i) build relationships with them as they have invited Mercy Ships to work in their country (ii) assess how the surgical services and healthcare education Mercy Ships offers can help their nation; (iii) assess the logistics of transporting in excess of 1000 crew backwards and forwards from Kinshasa to Matadi approximately 500 km away; (iv) assess feasibility of having 400 crew in Matadi with respect to food, water, leisure acivities etc. What struck me most was that Kinshasa was a city of contrasts and the DRC is a stunningly beautiful country. I admit to being a little scared beforehand. The DRC was afterall the poorest country on eart and I fully expected to be shocked at what I might find. I imagined a mixture of Freetown, Sierra Leone (people everywhere so it is hard to even walk in a straight line in the street) and Monrovia, Liberia they had not had running water of electricity for years making it impossible to deliver quality healthcare. Kinshasa was a sprawling city but despite 10 million people it was not as busy as Freetown, and the infrastructure was better than Monrovia. However, poverty was evident with some hospitals struggling for electricity, and equipment. As is common in other hospitals in west and central Africa the operating rooms are stark and bare…..and could be what you imagine a torture chamber to look like. But two hospitals in Kinshasa were some of the nicest I have seen in Africa. I was truly impressed, by renal dialysis units; neonatal intensive care units; CT scanners, MRI and mammography; fully equipped laboratories with PCR the only major diagnostic technique that was lacking; and fully equipped operating rooms and sterilising machines that seemed to work correctly and at the correct temperature. What a contrast between neighbouring government hospitals in the same city. Loic, one of our translators had grown up in the DRC as his parents were missionaries there and still are. His insight and understanding of the culture was immensely helpful in deconstructing the prejudices and fears I had arrived with. Rebels, rape, massacres. That is what we read in the news about DRC. A country ravaged by internal conflict, unstable, unsafe and corrupt. Foreigners advised not to travel here. TRUE, but all the trouble is far away in the east, near the borders of Rwanda, Burundi and Uganda. This is almost as far from Kinshasa as New York is from Texas. Yes, we did see evidence of corruption, and yes we had the inevitable border hassle as we crossed the Congo river from Brazzaville, Republic of Congo into Kinshasa, DRC and back again. But all the people we met in the hospitals, the port, guest houses, local workers such as taxi drivers and shop keepers, everyone was helpful and polite. A country of conflict but also one of kindness and hospitality. A country of contrasts. Matadi is in Bas Congo province. I was impressed by the beauty of the region and the kindness of the people. Rich green fertile hills and countryside. Towns of subsistent farmers, selling produce all along the road from Matadi to Kinshasa. Apparently the 3 countries, DRC, Zambia and Zimbabwe have the potential to feed the whole African continent. Having been to all three countries I can believe this. And there is a new hydroelectric dam near Matadi with huge potential for providing the region with electricity. The port in Matadi is having some renovations and will be ready for us by January 2015. So I am praying that our International Management Team decide to come here soon so we can have the privilege of walking alongside the people of the DRC and sowing seeds of hope and help them realise their amazing potential. The DRC, a country of contrasts. Jesus, a man of contrasts. Born into poverty in a stable yet he was a King. Eternal yet temporal. Life in heaven versus life on earth. And as I ponder these contrasts, I am also reminded of my own life. Poor yet rich. Earning no salary but witnessing the generosity of others who provide for all my needs. Sharing a cabin instead of living in my own house. Giving up everything but somehow gaining everything. The DRC is the poorest country on earth yet with great potential. And this Christmas, no matter what contrasts you see around you, may you know the potential and the hope that is in and around you too.

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.