2016 December

Vivien and Manatiry developed a special bond
Vivien and Mananatiry developed a special bond

Starship Health paediatric nurse Vivien Welsh always knew she wanted to work with children. She entertained both teaching and nursing as career options. But time with a Christian missionary organisation based in Brisbane and travelling in India and other parts of Asia convinced her nursing was the right choice. “When I was travelling, I saw just how much need there was for health care.”

Her first paediatric placement as a student and her pre-registration placement on a neurology ward at Starship confirmed she had made the right career decision. She graduated from Auckland University of Technology in 2012 and began her nurse-entry-to-practice placement on the neurology ward where she had worked as a third-year student. Welch loves the work.

“I love working very closely with families. It is different to working with families of adult patients. When a child is in hospital, a family member is there all the time and every shift we discuss with that family member what we hope to achieve. It is a real partnership.”

She has stayed on the neurology ward – “there’s still so much to learn”. But her time there has been punctuated by two stints as a volunteer nurse with Africa Mercy, the world’s largest civilian floating hospital, which was in Madagascar. The Africa Mercy is run by the international non-government organisation Mercy Ships. The first time – from mid October 2014 to mid-January 2015 – she worked on the ship’s paediatric ward. She resigned from her job to do so, but on her return successfully applied for a position on her former ward. Welch knew she wanted to return to Africa Mercy. For her second assignment of 12 weeks with the hospital’s dedicated wound care team, which began in early January this year, the ward accommodated her unpaid leave.

She feels compelled to do this work. “I want to make a practical difference and Mercy Ships provides the structure and support to do that. I also feel a responsibility to do so. I’ve been born in this country but have done nothing to deserve that fate; I could just as easily have been born in a country with nothing. I feel I have a duty to give something back.”

Six-year old Manantiry's arm and hand were immobilised by scar tissue
Six-year old Manantiry’s arm and hand were immobilised by scar tissue

Time with the dedicated wound care team was her way of doing so this year. “Working on the ‘dressings team’ was very different to any nursing I’d ever done before. Previously, I’d worked on the wards where I had a patient load. In the ship’s dressing team we definitely worked as a team, which was great. Five of us rotated, with four nurses on duty each day. We operated in pairs, alternating between performing dressing changes and distracting kids, while getting the instruments and dressings ready for the other nurses.”

There was always music playing, and dancing withher bandaged patients to Taylor Swift’s latest hit was a regular occurrence.

“Despite the seriousness of the conditions being treated, we created a fun environment to work in. There was always music playing. We sang and danced around with our patients – or solo – to entertain them! We always ended the day with our faces covered in stickers from the kids.”

A six-year-old boy, Manantiry, will always remain in Welch’s memory. He had pulled a pot of boiling water onto himself when he was two. His family lived in a remote village, had very little money and poor access to health care. She first met him during his initial dressing change one week after surgery on board. (See box on facing page.)

“He had  severe burn contractures and surgery released his scarring and he received multiple skin grafts. Dressings had to be changed on four different sites: his hand, axilla, elbow and the large donor site on his thigh.

“I had the job of distracting Manantiry and holding him still, while his surgeon did the first dressing change. It is something I will never forget. Manantiry screamed and screamed for most of the hour that it took.  I spent the entire time wrapping him in a hug and holding his arm or hand still for the surgeon. Manantiry stared directly up at me with his huge brown eyes. I spoke to him gently, reassured him, and sang to him. Through it all, I think Manantiry ended up trusting me more. For weeks afterwards, I was the only one he would allow to perform his dressing change. We formed a really strong bond. It was amazing to watch some of the movement in his hand restored soon after surgery.”

The basics of dressing changes

As her 12-week assignment was coming to an end, Welch was working in the ship’s dockside clinic doing outpatients’ dressing changes. Manantiry’s mother came to the clinic and told her they were going home, as a family member had died. The journey back to their small village took five or six days of difficult travelling. “She said they would return in a month because it would take that long to travel there and back. We quickly taught Mama the basics of changing the dressing and looking after her son’s wound. Before he left, he had 90 degrees of movement at his axilla.”

Welch later heard that Manantiry had returned to the Hospital Outpatient Extension Centre about three weeks after they were scheduled to arrive. His wounds had all healed but he had lost some range of movement because he hadn’t been doing his exercises. The rehabilitation team continued to work with him to regain that lost movement.

While Welch saw “crazy surgical presentations I’d never see in New Zealand”, the actual nursing practice on Mercy Africa was more akin to caring for elective surgery patients. “The nursing is not as acute as my nursing here – you’re not run off your feet so you can get to know the patients and their families really well. We could spend time hanging out with the kids, singing, playing, forming real relationships and seeing how much of a difference we can make. I loved that about it  and I certainly got more than I gave.”

Returning to New Zealand and re-entering a high-acuity environment, with acutely unwell children, takes a little adjusting to. But what she finds more of a challenge is some people’s attitudes. “All our patients have really nice single rooms but some people can still find things to complain about. They don’t realise how good we’ve got it here. We have access to free health care. In Madagascar, every intravenous line, bag of fluids, dressing pack etc must be paid for before you get any treatment. If you don’t have money, you don’t get help.”

Welch wants to continue making a practical difference. “I think perhaps it’s time to move on from the neurology ward and get some different experiences, keep challenging myself to learn new things and get new skills I can take overseas. I want to keep finding ways of working overseas, to keep learning and to keep becoming a better nurse.”

Published by Kai Tiaki, Nursing New Zealand December 2016. Posted with permission.

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2016 December

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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2016 December

Jonathan hard at work in the server room
Jonathan hard at work in the ship server room

West Africa is a completely different world to ours. It smells different, it looks different, the traffic is chaotic with motorbikes coming from all directions. One of the most significant differences, however, concerns the health system. It is basic and insufficient to serve the people of the country, not to mention that accessing even the most basic healthcare services can lead families into bankruptcy. Most people just learn to live with preventable and treatable conditions.

This year I had the opportunity to volunteer my time and IT skills in a West African country called Benin. I volunteered as an IT support specialist for an organisation called Mercy Ships, on board the Africa Mercy for three months. The Africa Mercy is a hospital ship which provides free surgeries and medical training to countries along the West African coast. Providing medical capacity building, surgical procedures and post-operative care to the highest standard, the Africa Mercy impacts thousands of lives in each country they dock in.

My time was spent fixing all sorts of IT equipment on the ship. The ship is a unique environment in terms of IT support. It contains a hospital,ship engine room, school, café/shop, hair salon, library, church, bank, and 450 crew members with plenty of personal devices on board. The rest of the IT team and I had to be well-organised and inventive to handle all the technology issues that were thrown at us. Our mission was to make a first world hospital run smoothly on a first-world ship in a third world country. By working and living on the ship

Jonathan Clark and his wife Stephanie Jonathan Clark and his wife Stephanie on the deck of Africa Mercy
Jonathan Clark and wife Stephanie on the Africa Mercy

24/7,when you do a job for someone you not only feel that you are helping the people of Benin but you also feel like you are helping out friends. This gave me a real sense of accomplishment in my job.

Volunteering for Mercy Ships has reminded me that customers and patients are the main reason I come into work every day. The effort I put into developing quality software will ultimately result in a better experience for those consumers and patients. I have also realized how blessed we are in New Zealand to have a reliable and affordable health system. There are so many factors in Benin preventing people from getting the care that they need. So let us be thankful this Christmas that we have the facilities and resources needed to have a safe and enjoyable holiday.

by Jonathan Clark, Software Developer at Orion Health

 

Find out more: The Toughest tech you’ll ever love

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2016 December

Dr. Tony providing anaesthesia on board the Mercy Ship
Dr. Tony providing anaesthesia

Benin, a small West African country between Togo and Nigeria, has severe resource constraints and a population of 10 million with limited access to health care. Mercy Ships will be in Benin for 10 months providing a range of surgical specialities: plastic and general surgery, gynaecology (fistula repairs), ophthalmology, orthopaedics, limited neurosurgery (specifically encephalocele cases), and dental and maxillofacial surgeries.

I found the Mercy Ships set-up to be very welcoming, professional and well equipped. Long before the ship had arrived in the country patients had been screened for suitability.

Initial screening took place in both metropolitan areas and in isolated rural villages with teams from the ship travelling far into the interior. The ship offers elective surgery for only benign disease and only where the course of treatment can be completed over the course of the ship’s stay.

Prior to their arrival on the hospital wards, patients had been checked by an experienced rural Australian GP, who had arranged for their bloods tests, ECGs and radiology. Severe hypertensives were postponed and started on treatment. Time had been spent counselling the patients in their own language about what was being offered, and expectations and likely outcomes. Final surgical consent was obtained the night before surgery, often with an inked thumb print.

The hospital is well resourced with five operating theatres, a post-anaesthesia care unit or PACU, an intensive care unit with adjoining high dependency unit (with the ability to ventilate post-operative patients), four post-operative wards, full laboratory services including transfusion – you have to love warm, whole blood when the suction bottle has reached the seven-litre mark – and radiology, including CT, ultrasound and plain film. Post-operative physiotherapy and extended-duration hand therapy was available.

From an anaesthetic perspective the theatres had Mindray anaesthetic machines, circle systems with Iso and Sevo volatile agents, oxygen/air mix, end tidal agent monitoring and the capacity for invasive monitoring in selective cases. A range of fibre-optic scopes were available along with C-MAC and Air Trac. Ultrasound was easily accessible for regional anaesthesia. Every theatre had an anaesthetic consultant and trained anaesthetic assistant.

The surgical pathology over my stay was varied, the sub-speciality surgery being dependant on the specialist skills of the surgeon who was onboard the ship at the time. I did plastics lists with lots of burn contracture-release surgery, removal of massive facial neurofibroma, MaxFax cases of ameloblastomas the size of watermelons requiring awake fibre-optic intubation (AFOI), subtotal mandibulectomy and plate reconstruction, lots of hernia repairs, and lumps and bumps. There was a mix of adult and paediatric cases.

Working with an international team of volunteers
Working with an international team of volunteers

There were plenty of times that I wished I had paid more attention during fourth form French classes but translators were readily available throughout the patient journey. Local people were very multilingual and one could always communicate with patients in one of their own languages including at induction and emergence.

The surgical wards were a very communal affair. It would be common to be seeing a patient for the next day’s list, asking questions about their past anaesthetic exposure, allergy or surgical pathology only to have those questions answered by the patient in the next bed with advice from visitors across the room. One notable general surgical list had three adjacent patients with four hernias between them. Much discussion ensued as to who had the biggest hernia, the stonemason, the fisherman or the jailer-turned-security guard. In the end the ward decided the fisherman was the victor given that he was scheduled for a bilateral hernia repair, but no one believed his account of the size of the fish he caught. The stonemason clearly had the toughest hands – mine were pronounced to be like a young girl’s – and the security guard laughed that the very people he was paid to keep in, he was now paid to keep out! It was certainly a unique pre-admission clinic!
With help from Mercy Ships and through contacts with the World Federation of Societies of Anaesthesiologists (WFSA) – thank you Wayne Morriss – I was able to spend two days at two local university hospitals observing. I was made very welcome by the two professors who patiently showed me through their institutions and allowed me access to the theatre complex. In Benin, medicine is a seven-year fee-paying course, at the end of which most graduates endeavour to specialise as soon as possible.

Sharing fishing stories during ward rounds
Sharing fishing stories during ward rounds

There is no universal health care; patients pay for medical treatment. Consequently Obstetrics and Gynaecology is the most popular choice given the young population and high birth rate. Specialist training takes four years during which the registrars receive no salary for their work.
The anaesthetic workforce statistics reported to me were staggering. Consistent with most of sub-Saharan Africa, Benin, with 10 million people, has 22 medical anaesthetists, and not all of them are in clinical practice. There are 250 nurse anaesthetists who do the bulk of the clinical work. The nurse anaesthetist school in Cotonou has trained 200 of the 250 but has been closed for the last two years.
Part of the role of Mercy Ships in Benin is to assist with medical capacity-building and education as well as clinical care. Accordingly they are running courses in sterilisation techniques, promoting the WHO Surgical Safety Checklist – which is not widely used – and promoting the need for a surgical count at the end of surgery to ensure all swabs and instruments are accounted for—also not used in the theatres I observed. In addition local surgeons and anaesthetists spend time working along expatriate specialists in the theatres onboard the Africa Mercy.
While in this environment, as a husband and father it was hard not to wonder what life would be like for my loved ones should the place of their birth have been different. It was a privilege to be able to make a small contribution to the lives of some very vulnerable people.

 

By Dr Tony Diprose, published by NZ Anaesthesia December 2016

Video link : https://vimeo.com/171768893 The Mercy Ships response to Global Surgical Need (3 min)

2016 December