Full and challenging yet fruitful

I would not describe myself as an avid reader but I often have at least one book on the go. Recently I have been reading one called ‘Crash the Chatterbox’ by Steven Furtick and a few days ago I read this,

“If you call your schedule busy, hectic, and overwhelming, that’s how it will feel. Your words will give weight to the very dread and discontent that the enemy intends to use to discourage you. But if you call your schedule full and challenging yet fruitful, it will begin to take on those dimensions, first internally and then externally.

I have noticed that certain seasons of my life that had the potential to be the most stressful turned out to be the most joyful and productive because I disciplined myself to think about them in terms of opportunity, not obligation.

I have also experienced the opposite far too many times.”

Last month I wrote about ‘Learning the unforced rhythms of grace’, and so it seems the theme has continued. “full and challenging yet fruitful”.... What a wonderful phrase and perfect to sum up the last 7 months and fill my heart with thankfulness as I finish my last 5 weeks here in Madagascar.

Seven months ago, in September 2014, after multiple changes of plan due to the Ebola crisis in west Africa, we announced we would be sailing to Madagascar.  Mercy Ships hadn’t been here for 18 years, we had no assessment reports like we normally do with which to plan our programs, and even if we had those reports there was little time to plan  - we would be there in 6-7 weeks. And if that wasn’t enough pressure /obligation (or as Steven Furtick would say, ‘opportunity’), there were sudden and unexpected changes in the leadership structure of the hospital. Within a matter of weeks, there was a new Hospital Director (responsible for nearly 200 staff), a new Ward Supervisor (responsible for about 100 nurses and rehab staff), and a new Patient Selection Supervisor (responsible for finding and screening literally 1000's of patients). I had been promoted to Deputy Chief Medical Officer and so together, as a brand new team, we faced, what could be described as "busy hectic and overwhelming" or “full and challenging" times.  And we prayed it would be fruitful.

The new Hospital Director, Kirstie was a good friend of mine so that helps in situations like this. I can vividly remember sitting on the beach in Tenerife just before we set sail for Madagascar. Kirstie and I, plus two other friends who we had asked to pray for us for wisdom and courage for us to face the season ahead. They then left us, and we sat, gazing towards the ocean, and prayed , asking the God of heaven to give us vision for the forthcoming field service to Madagascar. We wrote down several spiritual and medical goals that we felt God gave us. One goal was that we would not move ahead on any major decision without unity. So immediately we returned to the ship we shared these with Dr Gary the Chief Medical Officer, and veteran of 27 years with Mercy Ships. The 3 of us comprised the Hospital Executive Team. Unity would define us, and from there would spring other goals and the vision we felt God had put on our hearts.

Maybe another time I can share these goals with you, but for now I want to share the ‘fruitful’ part.  The hospital opened early November, so in almost 5 months (which would normally simply be the Advanced preparation and set-up phase) here are the statistics - the fruit of "full and challenging" times:

4,245 dental patients treated

1007 surgeries performed (671 adults; 238 children under 14 years)

44 participants in healthcare education mentoring projects

269 participants in 8 different healthcare education courses

            WHO Safe Surgical Checklist

            Lifebox / pulse oximeter

            Primary Trauma Care

            Basic Surgical Skills

            SAFE Obstetric Anesthesia

            Introduction to Ponseti

            Newborn Resuscitation

            Helping Babies Breathe

Now at short notice, that is ‘full and challenging yet fruitful’. Very fruitful. And that is a reason to be thankful.

At this stage in the field service with less than 2 months of surgeries left, people start to get tired, but I have found stopping to draw breathe and reflect on all that we have achieved brings joy and thankfulness, and that strengthens me. Especially this year, as I look back. No wonder I am tired, but wow – what an incredible field service.  This week, Kirstie asked the 10 key hospital leaders to review their goals for this field service – a standard management task as time draws to a close on projects. But this was not to just to see where/what we had achieved or failed – but to stop and reflect and be thankful. To actually make, and take, time to be thankful because it is in that posture that I believe new vision is birthed, even bigger dreams are conceived, and more fruit is ultimately produced. Thankfulness is the key to finishing this field service well  - with hearts full to bursting instead of exhausted, dry and burnt-out .

And it is not over yet.

This week we are running yet another healthcare education course, this time in Paediatric anaesthesia, in the capital city Antananarive, and the following week a shorter version back on the ship in Tamatave. I am excited to be welcoming friends from Canada, US, England and Kenya to help me as one of my dreams is to make sure every child has access to safe surgical care and in particular safe anaesthesia. Our other healthcare education mentoring projects continue for several more weeks and surgeries on the ship run until May 22nd. Plenty of time for more lives to be touched and transformed.

I am thankful for a ‘full and challenging yet fruitful’ time this year. I am birthing bigger dreams and visions for next year - an expanded surgical program, and country-wide plans for a number of healthcare education courses……but - more about that another time - till then....

Sweet dreams......full and challenging yet fruitful.

Unforced Rhythms of Grace

This month I thought I would start by sharing some statistics:

It has been busy. February, March April is often the busiest time for me. Our medical capacity building projects are in full swing, many of the big surgeries are happening as word has got out that we 'really can help people', and we are full steam ahead into planing projects for the next field service.

Jesus was busy too. Frequently we read in the bible that even when Jesus tried to move away from the crowd, or to find a quiet solitary place to pray, the crowds followed Him, or somehow managed to find Him. Never does He turn them away. Never is He irritated that they found Him and interrupted His plans. Always, He welcomes them, teaches them and gives......gives of Himself, His time, His talents, and his energy. How did He do it? How did He manage to keep up this seemingly relentless pace of life and at the same time always seem to be calm, and never stressed.

I have thought often about this, living and working where I do. Often there is little time to myself. Evenings, weekends, even first thing in the morning in the dining room, there is often something clamouring for attention, someone needing something, a visitor, a friend, a partner for one of our projects. How can I respond with the same attitude of Jesus?

Matthew 11:28-30 gives me a clue - "Come to me. Get away and you will recover your life. I will show you how to take a real rest. Walk with me and work with me, watch how I do it. Learn the unforced rhythms of grace. I won't lay anything heavy or ill-fitting on you. Keep company with me and you'll learn to live freely and lightly."

I spent some time in my hammock today. Resisting the temptation to answer emails, do more work. And I mediated on this verse. What does it look like to 'learn the unforced rhythms of grace' - even in the heat of the busyness? 

Most of the time it is pleasure, a privilege, a honour to respond to the demands on my time - just like Jesus did.  With joy and grace. But sometimes it is hard. Sometimes I wonder how on earth I will get everything done. Sometimes it just feels too busy. It is at times like this that I remember, how time and time again, Jesus gives us what we need, when we need it. SO many times in my life I have felt like  - 'God just expanded my time!' I don't know how it happened, but it did. A car journey that was supposed to take 8 hours, takes 5-6. A piece of work gets done much quicker than expected. A sick patient gets better quicker than expected - miraculously so - and I end up with a whole extra day I didn't anticipate. Yes, I HAVE SEEN ALL THESE THINGS. So I am learning to trust that there is a time under the sun for everything. 

So right now in midst of a very busy season I am trying to 'come to him.....let him show me how to take a real rest.....Learn the unforced rhythms of grace.' And to believe his promise that he really, truly 'won't lay anything heavy or ill-fitting on me.' And that His desire for me is that I 'live freely and lightly.' 

And the more I fix my eyes on him, the more I know that it is possible, even in the busyness, even with all that is on my plate. 

SO I look forward to writing again in a months time, with more statistics and more stories. Testimonies to an incredible God, who is the same yesterday, today and forever. 

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%.