Making essential surgery accessible

Crowds wait for the chance for free surgery
Crowds wait for the chance for free surgery

Lack of access to safe surgery results in more deaths worldwide every year than HIV, tuberculosis and malaria combined, according to the World Health Organisation (WHO).

There is growing international acknowledgement of what theatre staffs have long known and advised: accidental trauma, birth complications and the lack of surgical intervention for amenable disease conditions causes millions of people annually life-long disability or death.

Empowered by the rising profile given to the accessibility of surgery in developing nations by the findings of The Lancet Commission on Global Surgery a movement has begun; a new determination to make access to safe and affordable surgery for the poor a reality.

For nearly 40 years Mercy Ships, the hospital-ship charity, has quietly made it a priority to provide safe surgery for people who otherwise would have no options. Mercy Ships joined the newly formed Global Alliance for Surgical, Obstetric, Trauma and Care (G4 Alliance) in 2015. The Lancet Commission’s report was published later that year with a vision to ‘embed surgery within the global health agenda, catalysing political change, and defining scalable solutions for provision of quality surgical and anaesthesia care for all.’ Together these bodies are stimulating a growing recognition that safe surgery must be an integral part of the global health agenda.

Esther Meyer enjoying down time on deck with some of her patients
Esther Meyer enjoying down time on deck with some of her patients

During 2014–2016 the Mercy Ship Africa Mercy completed two ten-month tours of duty in the island of Madagascar, off Africa’s eastern coast where 95% of Madagascar’s 23 million people live on less than $1.25 per day to cover all their needs: food, shelter, clothing, education and healthcare. Since much of the population lives in remote villages, it was common for patients on the hospital ship to explain how they had walked for days – sometimes carrying a child – to reach any public transport. From this point, basic healthcare may be accessible, but at a crippling cost. Before any treatment is undertaken, the patient must pay for – and sometimes even source – sutures, IV bags and fluid, dressings, bandages and pharmaceuticals, everything that is needed for treatment. So when free reconstructive or life-saving surgery was offered by Mercy Ships, patients and their families often broke down with tears of relief. Few had any other options, or even hope, for healing.

While in Madagascar, Mercy Ships launched a mobile education team. The ‘Checklist’ team of three to five doctors and nurses travelled a gruelling 16,829 kilometres to every regional hospital, even in the most inaccessible areas. They coached local healthcare professionals in the understanding and use of the WHO Surgical Safety Checklist. This simple tool helps any surgical team to improve safety in surgery. It has been proven that using the checklist has decreased operating room mortality by nearly 50% and significantly decreases surgical complications and infections.

In New Zealand and many parts of the world, this checklist is now mandatory. In Madagascar it was not utilised effectively. Mercy Ships came alongside every region in the country and assisted them in creating their personalised checklist and provided the participating hospitals with pulse oximeters.
Safer surgery is being performed throughout Madagascar as indicated by a follow-up visit after three months which showed a Checklist usage rate of 80%. Further assessment will take place in 2017. The Checklist team collected national healthcare data never previously compiled, and worked with other organisations to support the government in developing a national surgical plan.

In August the Mercy Ship sailed to Cotonou, Benin where the crew have 10 months to engage in medical capacity-building and provide healthcare for thousands more Africans in desperate need of both hope and healing.

Esther Meyer
Each year dozens of New Zealanders – including theatre nurses, anaesthesia staff, surgeons and other healthcare professionals – volunteer with Mercy Ships. The not-for-profit is Africa-focused, with a mission to provide free surgery for those in greatest need, and to train medical professionals to continue their work long after the ship departs.

Esther Meyer, theatre nurse from Drury volunteered for five months in the on board theatres during 2014, in the Republic of Congo. She found it to be impacting both on a professional and a personal level. Esther explains, “As the Mercy Ship is a floating hospital it is able to move to different locations, while still providing an excellent standard of care. It provides a place where local health professionals can come on board to learn valuable skills, without having to leave their own country.

“The camaraderie between the volunteers is unique. No one gets paid and there is no hierarchy in the operating room. We worked hard as a team with all the same goal in mind. The operating room is a fast paced and fast turnaround of staff. In New Zealand we have a wide range of ethnicities, so it wasn’t hard to feel at home. There is a mixture of British and American terminology inside the operating room, but plenty of understanding and patience. Laughter helps to break down barriers, and friends are made quickly. To be able to serve alongside such knowledgeable people, and to have the opportunity to learn from them, was very exciting.

Posted with permission by The Dissector December 2017

Video link : The Mercy Ships response to Global Surgical Need (3 min)