New Plymouth-born pharmacist Gray Barnett has gone to sea… His role comprises a mix of community and hospital pharmacist.
Pharmacy Today magazine – February 2018
by Nerine Zoio
New Plymouth-born pharmacist Gray Barnett has gone to sea.
For 10 weeks during December 2017 and January, he volunteered with Mercy Ships New Zealand, providing medical and surgical care to people in desperate circumstances on Africa’s west coast.
The Christian-oriented Mercy Ships are essentially floating hospitals operating all over the waterways and coastlines of developing nations.
Mr Barnett’s ship, the Africa Mercy, docked in August, in Cameroon, where it is spending eight months treating patients from all over the country.
On board, his role comprises a mix of community pharmacist and hospital pharmacist.
“I guess what personally motivates me to volunteer is to give freely of my expertise as a pharmacist, and to provide a level of care to patients that could be expected in New Zealand or Canada,” he says.
“I think that’s important, and it’s very satisfying to help in this way.”
The ship screens patients to determine whether surgery and a successful outcome are feasible before taking them on.
Unlike a standard hospital, on Mercy ships specialist surgeons from all over the world volunteer to undertake a limited scope of surgeries.
The ship’s 80 beds are often filled by patients for much longer than the night or two expected in a New Zealand hospital, due to lack of medical infrastructure to manage complications once off the ship.
Meanwhile, a “hope centre”, akin to a Ronald McDonald House, provides an area for patients and their families as further recovery takes place.
Most patients seen on board are medically stable, but still require wound care, physiotherapy and occupational therapy.
Not speaking French does not hinder Mr Barnett from building relationships with patients.
“I experience many special moments, like when I receive a gentle smile or shake hands with a patient, which means a lot both to patient and practitioner,” he says.
His typical day consists of attending to ward rounds, monitoring medicine quality, ensuring optimal medication usage outcomes, and acting as a community pharmacist for the crew.
Pharmacists on the ship act as “safety nets” because the senior doctors lack their teams of younger registrars and house officers back home.
“Pharmacists have a bit of a role to play, catching a few more issues normally managed by junior doctors,” Mr Barnett says.
Along with three other pharmacists, he often finds himself compounding creams, ointments and suspensions, although this is made difficult by the lack of a sterile unit.
Challenges include the small size of the pharmacy, the limited formulary and supplying the ward’s medicine cabinet, including fluid supply.
‘What personally motivates me to volunteer is to give freely of my expertise as a pharmacist and t provide a level of care to patients that could be expected in New Zealand or Canada. I think that’s important, and it’s very satisfying to help in this way.’
“Half of the pharmacy, which is on the same level as the hospital, is run out of a container, with stores being held at another part of the ship,” Mr Barnett says.
“This means we’re constantly tripping over ourselves to run a pharmacy out of a very small dispensary and container, as well as the challenge of needing to leave the hospital area to get to the supply area to get medication.”
The team’s senior pharmacist manages logistics. It can take up to three months for a medication order to come through from the US, the Netherlands, or the UK.
“The ship can buy medicine locally, but that constitutes a challenge as it is next to Nigeria, the counterfeit capital of the world,” Mr Barnett says.
“Recently, we ran out of intravenous fluids, which now requires us to source from a local manufacturer.”
The surgeons on the ship provide a wide range of general surgeries, including dental, eye, maxillofacial, plastic reconstructive, orthopaedic, and women’s health.
Many of these surgeries treat conditions not normally seen in New Zealand, such as elephantiasis caused by a parasitic worm, or severe clubfoot.
The obstetrics surgery mainly concerns fistula correction after childbirth. This occurs when an infant becomes stuck, placing pressure on the tissue around the uterus, anus and bladder. This results in necrosis of the tissue, loss of the child and inability to carry children until the condition is treated.
“It’s also associated with social stigma and social isolation, as the ability to bear children is culturally important in West Africa, and because of involuntary bowel movements or urinary incontinence,” Mr Barnett says.
There are many accidents around open flames in Cameroon and other West African countries and, because some of the injured don’t get high-quality care, burn contractures occur, he says. Often people are disfigured and lose range of movement in their limbs.
The Mercy Ships plastic surgery team does its best to correct the contractures, to restore functionality and for cosmetic purposes.
“Because some of the burns are so severe, it’s often hard to get the perfect cosmetic look. But at least more dignity is brought back into patients’ lives, and function is brought back to their extremities.”
Paediatric neurosurgery is especially conducted on patients with hydrocephalus to enable cerebrospinal fluid to drain out of the brain, rather than accumulate.
“Hydrocephalus causes certain parts of infants’ faces to bulge because the skull hasn’t fused, pushing the brain out. Many other things can go wrong, such as delayed cognitive development, sensory issues, epilepsy and, if severe enough, death can occur,” says Mr Barnett.
“The fortunate thing is that, if we can catch it in time, it won’t have an impact on their survivability going forward in life.”
Goitre is another common ailment. “We see goitre that is so severe that it can end up killing the patient by collapsing their airway.”
Whatever the condition, the ship’s interventions bring immediate help, Mr Barnett says.
“I reflect on what a difference we’re making; that patients can leave our ship and go on with their lives with more function and dignity.”
Mr Barnett grew up in New Plymouth and studied at the University of Otago.
Recently, he moved to Canada, where he is in the process of becoming licensed as a pharmacist.
SHIPS OF HOPE: In the past 40 years, Mercy Ships New Zealand has conducted 85,000 free surgeries and trained 40,000 healthcare professionals.
In the past year, it has performed about 3000 cataract surgeries.
In addition to surgery, Mercy Ships is focused on building health expertise,infrastructure and sanitation within a country.
“Teaching the local doctors and nurses to provide care and building healthcare capacity in the local community are focal areas, so that when the ships disembark, services can still be provided,” New Zealand pharmacist and Mercy Ships volunteer Gray Barnett says.
“This involves the donation of equipment, and connecting hospitals with other organisations that can donate equipment to conduct surgeries.”
Mr Barnett says pharmacy technicians are required, and any volunteers would be welcomed.