Physios play key role in mission of Mercy

Hannah fitting Jimmy's prosthesisHannah Rutherford recently volunteered with the world’s largest civilian hospital ship, the Africa Mercy. The Mercy Ship was docked in Madagascar, and Hannah describes how she was impacted professionally and personally as she worked alongside the international teams providing healthcare services to people in extreme poverty.

 

After studying at Otago University and graduating in 2010, Hannah worked for Counties Manukau District Health Board for two and a half years before moving to Sydney in 2013. In Australia I work at the Sydney Adventist Hospital as a cardiorespiratory physiotherapist.

 

“I first heard about Mercy Ships from a colleague whilst working as a rotational physiotherapist at Middlemore Hospital for Counties Manukau. Her enthusiasm was contagious. My desire to travel and learn about another culture meant this organisation caught my interest immediately. What I didn’t realise at this early stage was that the Mercy Ship would offer me so much more than an opportunity to work abroad as a physiotherapist,” says Hannah.

 

Mercy Ships is an international NGO that has operated a fleet of hospital ships in developing countries since 1978. They enter port cities at the invitation of a country’s government. They then work in that country alongside government, international and local NGOs and local church partners for 10 months of field service Their aim is to support a country’s health delivery by providing training and completing medical-capacity building projects. This leaves the country with a much stronger and sustainable healthcare system at the completion of the field service. Throughout each field service they also address immediate healthcare needs by providing thousands of free surgical services that are not available within the host nation.

 

Burns paitents need pysio to regain movement after surgeryHannah had the privilege of living and working on the Mercy Ship from January to May of 2016. The Africa Mercy houses a crew of 450 volunteers from around the world. The lower level of the ship is largely taken up by the hospital. The ship has five operating theatres and eighty inpatient beds over five wards. It is supported by dental, pathology, radiology and, of course, rehabilitation services.

 

Hannah worked as a member of the rehabilitation team alongside four other physiotherapists and two occupational therapists. The main role of the rehabilitation team is to provide therapy services to patients receiving orthopaedic or plastic reconstructive surgery. The team also treats patients from any specialty if a need arises, and even members of the crew for urgent musculoskeletal conditions. Whilst in Madagascar, Mercy Ships provided 99 orthopaedic and 102 plastic surgeries, in addition to hundreds of other surgeries, free of charge.

 

“While I was on the ship, the bulk of our caseload consisted of patients with congenital deformities, severe wound infections, or burn scar contractures that required plastic surgery.”

 

The rehabilitation team worked on the wards and in a military-style tent on the dockside. The tent at times housed six therapists and five interpreters, all working with patients and their families at the same time. This, along with the language and cultural barriers, limited resources and a restricted time frame, added to the challenges we faced with the clinical work they were doing.  “It was the craziest, but equally the most supportive, work environment I have ever been in. Many of the conditions we treated were made more complicated by the delays in the patients accessing health services,” says Hannah.

 

As a team they had many brainstorming sessions where they shared their expertise and supported each other in problem-solving the unique issues they were presented with. “Somehow we always managed to find a way to provide the best care for these patients. I believe we covered almost every area of physiotherapy while I was working there. One moment we would be prescribing bubble PEP and other respiratory treatments for a five-year-old, and then treating a man who had ataxia following a severe head injury. There was lots of shoulder rehabilitation following axilla releases, hand therapy and treatment of musculoskeletal injuries. In addition, we were making all of our splints and orthotics. We had limited resources for this and often had to get creative with our designs.”

 

Hannah volunteered as a physio in MadagascarHannah’s Mercy Ships experience was a huge learning curve and an opportunity for growth both professionally and personally. “It was the most rewarding work I have ever been part of. As physiotherapists, our goal is to restore function. We were part of a team that provided a service that completely changed these patients’ lives by restoring a function they thought they had lost forever. With these patients we had the opportunity to help them regain movement in a limb where previously there had been none. It was the coolest gift you could ever give someone.”

 

“I met Jimmy on my second day in Madagascar. Mercy Ships had offered him a below-knee amputation, and he presented limping, with his leg wrapped in a filthy blanket and covered in flies. Jimmy told us his leg had been badly burnt when he was 11 years old, and the wound had never healed. Now aged 28, his leg was so badly infected the bones were exposed and he could not weight-bear on that leg. Mercy Ships offered him a below-knee amputation, and following this Jimmy’s rehab was initially straight forward, involving stump bandaging and strengthening work. Our first real challenge came when we decided to make a temporary prosthesis so that he could start partial weight-bearing. This involved some trial and error with the resources we had on hand, but we eventually had an effective prosthesis made out of casting material and the end of a crutch. Jimmy’s progress was nearly derailed by the growth of a bone spur at the end of his tibia. The original surgeon’s volunteer service had concluded by then, so we asked around the group of surgeons on board at the time if anyone would be comfortable operating on him. One plastic surgeon, whose specialty was facial surgery, offered to help.

 

Because Jimmy had to return to theatre for the spur removal, he was not ready for a prosthesis until our last few weeks in Madagascar.  We paid a local prosthetist to make him a permanent prosthesis; it cost about $80 and took one week to make. Jimmy would never have found the money to pay for it himself. He quickly and competently took ‘on board’ everything we taught him. He was walking unaided his prosthesis by the time Mercy Ships bade farewell to Madagascar’s shores.”

Posted with permission. Physio Matters, December 2016. Publisher Physiotherapy New Zealand

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