Extra note for this month...

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New Orleans

New Orleans

This year the American Society of Anesthesiology (ASA), a meeting of approximately 15,000 anaesthesia doctors from around the world was in New Orleans. For the last 3 years I have been invited by the ASA to help run the ‘Paediatric difficult airway workshop’ at their annual scientific meeting. 

I had a research background in this topic before working with Mercy Ships and now the work we do is on the ship is highly relevant. As an ex-colleague of mine once put it, ‘we see the world’s most difficult airways’. And I think he is right. For those non-medical readers - management of the airway is a key skill for anaesthetists as it helps us keep you alive when you are under general anaesthesia! And usually this is straight forward, but it can be difficult and if this occurs unexpectedly then your anaesthetist doesn’t have very long to react (literally minutes) to keep you safe. In other situations one can predict that a patient will have a difficult airway and employ various techniques to ensure patient safety – but some of these are complex skills and especially so in children.

This meeting has always been highly valuable resource to me. Not only for attending various sessions to maintain my own continuing medical education (a necessary part of retaining my medical licence) –but also for the people I have met. There is a large community of global health experts at the meeting – all of whom are working hard to make surgery safer in low income countries, discussing how to teach and train and this environment, and what metrics we should be measuring. At this meeting (and the surgical equivalent), there is a coming together of some of the sharpest minds I know.  A trading of ideas and brain-storming of possibilities. This for me is one of the most stimulating and rewarding parts of the meeting and I am privileged to be a part of these discussions. It has honestly helped shape the Mercy Ships Medical Capacity Building Strategy that I have developed over the last 2 years since late 2012. And this year, in New Orleans it was no different.

I could only attended half the meeting due to Mercy Ships sailing schedule but as always, God seemed to manage to connect me with the right people. On one hand I was encouraged to hear that everyone is wrestling with the same issues as we are.  Mercy Ships is doing a good job. We are pioneering the way along with others. There are no experts in this field – we are all very much learning and very much aware of the problems of difficulties. So, on the hand I was fighting discouragement –there are no easy answers, no sure strategy, no ‘quick fixes’. Teaching and training, or to use the buzz words, ‘sustainable capacity building’ is just sheer hard work, and it takes a long time and a lot of effort to see any change.  Someone at Mercy Ships recently asked if we could get an ‘expert’ to come and talk to us about capacity building – I would love that – just don’t know where to find them? I don’t feel like I am the expert, but no-one does.

The other wonderful thing about the ASA meeting that deserves mention is the people I meet. People of good character, passionate about patient safety, passionate about improving healthcare globally and very generous with their time, ideas, skills and resources. Many of them have blessed me personally over the years and generously supported me financially and intellectually. This year was no exception – and I am extremely grateful. Not all of these friends were there this year (there is another big meeting in Boston next month with our surgical colleagues) – but they are never far from my thoughts, and we are in constant contact as we continue to work together.

SO Mercy Ships is headed to Madagascar and we sail from Cape Town on Thursday 16^th, arriving Saturday 25^th October. I am so glad we are nearly there. It has been a long time since our floating hospital was open and so many changes of plan due to Ebola. We have had a manic time getting ready in just 7 weeks. Normally we assess a country at least a year in advance and can start making plans for sustainable capacity building and plan the follow-up metrics arrangements. This current schedule makes things very hard. Not to mention all the other logistics surrounding getting the ship into the port with the right berth space, water availability, customs and container logistics, suitable sites for our off-ship projects such as eyes and dental, transportation issues for crew and patients (port city is 8 hours from the international airport). We are fortunate to have a very capable and hard-working Advance Team on the ground in Madagascar now making all these preparations. And with reference to Medical training – I am so grateful for our Project Manager, Krissy who is there right now, meeting people, and making relationships so we can do as much training as possible and start as soon as possible. It has been exhausting for all involved – both on the ship and on the ground in Madagascar.

New Orleans was an interesting place. In many ways it reminded me of Africa – the temperature, the people. Also, one thing struck me – just outside the cathedral were row after row of mediums, fortune-tellers, people offering to read your palm, or check your Taro cards. I am never sure why we are so fascinated by knowing the future – if I knew how much hard work the last few months had been would I have stuck with it? Often we want to know the good but not necessarily the hard things! Inside the city cathedral were all the trappings and religious paraphernalia one would expect. The whole scene reminded me of the time when Jesus went to the temple (Luke 19: 45-48) and started getting rid of those who were selling things and said ‘my house will be a house of prayer but you have made it a den of robbers’.  Thankfully I can trust my future to Jesus and I don’t need a fancy temple or a fortune-teller to do that for me. The church today is made up of people and not just a building. Jesus doesn’t live in a building he lives in our hearts, and through prayer I can access the mind of God. I don’t need a fortune-teller. I can pray and talk to Jesus anytime, anyplace and he guides me and my life and helps me as I plan the capacity building strategy for Mercy ships. And that is Good News, when, as I said above – there are no 'real experts' to show us the way forward.

'whatever you do for the least of these you do for me'

These are not easy times, but they are incredible times.

We delayed our departure to Benin so we could monitor the Ebola situation especially in nearby Nigeria. The Ebola cases in Lagos were less than 120 km from where our team was preparing for the ships arrival in nearby Porto Novo, (the capital of Benin) and Cotonou (the large port city). However, the Ebola situation in Nigeria was far from contained – as those who have being following the news will know. Therefore we took the decision to cancel the ships deployment to Benin for this year. This was a very difficult decision. But crew safety was important, and also a desire not to worsen the Ebola situation was at the forefront of our minds.

How could we worsen the Ebola situation? Our ship, offering free healthcare, acts like a large magnet. Many people travel great distances in search of help. Countries in West Africa are like Europe, where the national borders are easily crossed and are no barrier to people movement. We frequently care for people outside the host nation who come to the ship, desperately seeking help. So being in Cotonou Benin, where literally hundreds of people cross the border back and forth to Lagos, Nigeria each day, was considered not a wise idea. The best thing to control Ebola is to restrict the movement of people, not encourage it. 

Our Advance team have been in Benin since April preparing for the ships arrival. They have hired approximately 200 local people to help us and had begun training them. Literally hundreds of posters have been distributed, radio and TV announcements were advertising our main patient selection on September 9^th. Applications forms for our healthcare education programs have been collected and two large ship containers were in Benin full of equipment and supplies – ready and waiting for us. Suddenly it is all change.

For the last few weeks this same team have been packing up, and pulling out. The radio and TV announcements now tell people that the patient selection is cancelled. However, some people had already started turning up – so sad. The 200 people hired for the year are being told they will no longer have a job. Thankfully the newly renovated buildings that we would have used for our dental clinic and Hospital Out Patient Extension (HOPE) Centre will still be able to be used. So at least we have left something behind. But then again, I believe it really is more than just buildings that we have left behind.

On one level it seems like we went to Benin and gave the people hope, and then that hope was snuffed out. But that is only part of the picture. We will be back – just not sure when. Benin will remain in our hearts and prayers because Mercy Ships is committed to West Africa and we are committed to serving the poorest of the poor. And now after Ebola, this region will be poorer than ever, especially countries like Guinea, Liberia and Sierra Leone. At times like these I take my hope from the words of Jesus,  ‘whatever you have done for the least of these you have done for me’. So every encounter, every smile, every hand shaken by our Advance Team was a Jesus encounter. A chance when love was shown, hope was sown, and an opportunity for more was born. It isn’t just about Mercy Ships bringing a hospital ship to a city. It is about people having hope for the future. The ship might not have come to Benin, but love did. Love in the form of a small team made up of 8 friends of mine, who poured heart and soul into Cotonou and the surrounding areas. Why? Ultimately because they believe in something bigger than Mercy Ships. They believe in a God who can bring hope and healing in ways the ship can't. Ways bigger than simply healthcare. They believe in a God who can make all things new. They believe love has a face and so do I. And that is one of the reasons I am here and why I do what I do.

And the great things about belief and faith like this is, that despite these very sad, very real, and very devasting consequences of Ebola – love still has a face. Every encounter is a Jesus encounter. My heart goes out to the people of Benin, I have been there twice before and I was looking forward to going there again. And I pray for the opportunity to return. But meanwhile, God is expanding our territory. No longer is Mercy Ships limited to West and Central Africa – we are now headed to East Africa. We will be serving the people of Madagascar instead. They are excited about the opportunity to host us and we are excited to be going. Sadness on one hand for Benin, but on the other hand - so thankful for the opportunity to spread our surgery and capacity building efforts to another part of Africa, Madagascar……here we come.

Extra note: ‘Love has a Face’ is also the title of a book by Michele Perry, which I highly recommend.