The lack of access to safe surgery results in more deaths worldwide every year than HIV, tuberculosis and malaria combined, according to The Lancet Commission on Global Surgery.

For nearly 40 years Mercy Ships, the hospital-ship charity, has quietly made it a priority to provide safe surgery for people in developing nations who otherwise would have no options.

The field of service for the Africa Mercy is primarily West Africa, where the international volunteer crew of 450 spend 10 months at a time in a nation at the invitation of the local government. The protocol promises the provision of free surgical care in ophthalmic, maxilla facial, burns and plastics, obstetric fistula, cleft lip and palate and orthopaedic specialties for people in poverty. Building the capacity of country’s existing health care workers is a second track of growing emphasis for Mercy Ships.

The Africa Mercy has five operating theatres, five wards and all the required axillary services such as radiology, pharmacy and pathology. Ponseti, physiotherapy and rehabilitation services, ophthalmic and dental clinics are facilitated ashore – all without charge to the patients.

Senior biomedical technician Tony Royston has volunteered with the Africa Mercy for a decade. He says, ‘The Mercy Ship is a first world hospital with good quality, modern and appropriate equipment.  Unlike the hospital locations ashore, we have stable power and environmental control that keeps the equipment optimal.’

He explains that locating a hospital on a ship provides its own unique challenges. ‘Storage space is very limited, so we rationalise the equipment’s make and standardise.  Most items are shipped in containers which take a few months to arrive, so we keep the necessary spare parts.’

Tony describes how the nature of the crew also adds a dimension of complexity. ‘A major consideration when choosing equipment for this environment is for it to be user friendly. The international clinical crew may be seeing that specific model for the first time and need to use it soon after they arrive. ‘

While the surgeries are conducted on board the ship, Tony and the team are also responsible for maintaining the equipment used by Mercy Ships teams ashore. ‘Dental, eye and other clinics are set up ashore each field service.  Because of unstable local power supplies, and dusty, hot and humid conditions the equipment has to be rugged and durable. A different country each year may require modifying building infrastructure, adding temporary cables, air hoses and other items. Everything must ensure safety and reliability for the patients and clinical teams.’

Tony recalls one of his most technically demanding assignments; ‘Getting our single slice CT working after a hard drive failure was a major trial. The part was impossible to find, so I persuaded the machine to work with a modified newer drive. I discovered a programmer had long ago written an error message for a too- large drive capacity that said, ‘No way, you can’t be serious, that’s humongous! ’ Every piece of software including the calibration backups had to be reloaded. At the time I was the only Biomed on-board. A patient needed a CT ASAP. It took many long hours.’

Tony found his role on the hospital ship to be both compelling and rewarding. In recent months during the current field service in Cameroon, West Africa he was called upon to help out a local hospital. ‘We found out that a hospital had an x-ray machine that was not working despite three attempts to repair it. It was the only x-ray machine in a region with a very large population.

‘The machine was brought from the other end of the country to the port city for us to look at. The machine was almost 30 years old, and we had to do the repairs to component level, which is uncommon these days.  We were able to fault find and repair it. We replaced some other old parts and gave it some much needed general maintenance.

‘Biomed training is so important,’ Tony declares passionately.  ‘Medicine and surgery rely on diagnostic and therapeutic equipment.  Unless there are capable, trained and supported Biomeds in the countries we visit, much of the other medical capacity building work we do on behalf of the local Ministry of Health will not be sustainable.  Many of the local Biomeds are very capable people but have not received any specific Biomed training. It’s a privilege to help them apply knowledge and skills in their own environment.  They are certainly able to teach us how to be resourceful in sometimes challenging circumstances.’

During each field service in a different African nation, Mercy Ships provides Biomedical Technician training. It is a means to improve a country’s overall healthcare ecosystem and to improve biomed services by providing assignments and projects designed to help technicians improve their understanding of equipment diagnostics and repair techniques. It helps the local participants to take ownership of their biomedical engineering service, to learn and apply these skills to enhance their professional interactions with clinical personnel and hospital management. They often need to be reminded that they are a valuable part of the healthcare team.

During the recent August 2017-June 2018 field service in Cameroon, Mercy Ships collaborated with the capital city’s hospital and with the Ministry of Health to provide repairs and renovations. This work was done in line with the hospital’s planning that was carried out for the biomedical workshop. Once the renovation work was completed, Mercy Ships returned the facility to the hospital and the Ministry of Health for their continued use. This increased the sustainability of the mercy Ships field service as the facility will remain in operation long after the Africa Mercy departs.

The facility was used during the field service for the Biomedical Technician Training project, during which 28 Cameroonian biomedical technicians attended training courses run by Mercy Ships.

During the 10-month tour-of-duty in Cameroon, more than 2,700 people in poverty received free essential surgery on board the Mercy Ship. For a complete field service overview view here

Thanks to NZ Institute of Health Engineers, International Federation of Health Engineers, and HealthCare Facilities magazines for publishing this article

The first time Julienne was called a witch she was too young to understand the implications – but the rejection was all too plain. Julienne may have been an outcast, but she was also an overcomer. Here is Julienne’s remarkable story

Ousman was excited to receive the call from his sister saying that his niece had finally been born. However, that excitement quickly turned into heartache once he learned that baby Aminata had been born with a cleft lip. When he heard the distress in his sister’s voice, Ousman felt desperate to help both her and her child.

As she grew, young Aminata’s condition began to cause malnutrition, making her body develop very slowly. At eight years old, Aminata’s height and build resembled that of her four-year-old cousin’s. Because she was ashamed of the way she ate, she refused to eat in public and instead, would only nibble on meals that were placed around the house for her to find.

‘Aminata would only eat by herself, and she found it hard,’ Ousman explained. ‘Other children used to laugh at her and say that her mouth was always open when she ate. Even with the safety of family, she was ashamed and would only eat alone.’

Ousman spent many years listening to the cries of his sister, begging him for help. He shared her pain, saying, ‘My sister cried every day for Aminata, and I told her I would find help. Knowing I was searching in the city was the only thing that kept her calm.’

After eight years and several failed attempts to find a solution, the family had all but given up.

‘It was a very sad time because we knew surgery was her only hope and we just couldn’t get it,’ Ousman said. ‘It was sad to leave her this way, but we had no other choice as we couldn’t afford to do anything without help.’

One day, Ousman heard an advertisement on the radio about a ship that offered free surgeries. After hearing about the patient selection process, he wasted no time in rushing to collect Aminata from the village. Unfortunately, by the time he returned to the capital, they had missed the screening. Ousman, however, was not ready to give up. He took Aminata straight to the Africa Mercy to see if there was anything Mercy Ships could do to help her.

‘In the village, we are very poor, and this ship was our only hope,’ Ousman said. ‘I feel responsible for Aminata because if she was to grow up she would be outcast and I could not let that happen. I am the only sibling in the city, so I had to do something.’

Once Aminata was accepted as a patient, Ousman was excited to make the call to his sister letting her know the fantastic news — Aminata was going to receive surgery! Following the surgery, Aminata was able to heal knowing that her family had never given up on her.

‘To give up hope would be the end,’ Ousman said. ‘We did not think about what would happen if she did not get surgery. We held on to the hope we had… Now, she has so many more opportunities, and we are so blessed. We are so thankful for all that was done for our family.’

In the morning Confort put on a pot of boiling water to make some rice for her hungry daughters. She never imagined it would be the start of a nightmare for her family.

One-year-old Gamai, who had just started walking, toddled past the pot knocking it over as she fell. As the piping hot water spilled onto her torso, her piercing screams transcended through the house to her mother’s ears. The world around Confort fell silent as she tried to comfort her child.

‘My imagination took me to places a mother dares not go,’ she recalled. ‘I fell to the floor clutching my baby.’

Confort and her husband rushed Gamai to the local hospital but were only able to afford some ointment for the pain. Not knowing what else to do, they reluctantly watched their little girl grow over the next few years with contracted hands and arms, severely limiting her mobility.  Attempts to live their normal lives began taking its toll on the family due to the scorn Gamai faced from other people.

‘If we went out and she was mocked, she would become shy and cry,’ Confrot said. ‘My husband would be cross that I would put her through that. I was stuck.’

The decision was made to keep Gamai from the outside world, and for three years she was kept isolated in the courtyard of the family compound to avoid mockery. Confort shared her daughter’s pain saying, ‘I became very sad and angry that this was the way my daughter was going to grow up — hidden from the world.’

Then one day, in the midst of Confort’s anxiety, she learned of an opportunity for people to receive restored mobility from an operation — a specialty of Mercy Ships. When the ship arrived in Guinea, Confort made the brave journey with Gamai — now 4 years old – out of the family compound to the patient selection site.

There she was met by fellow mothers who had gone through similar accidents with their children, and she began to feel at ease. That same ease developed into hope, which eventually grew into excitement as Gamai was selected for surgery onboard the Africa Mercy.

“I am filled with happiness that being hidden will not be Gamai’s future,’ says Confort.

But even after surgery, the journey wasn’t complete. Weeks of painful rehabilitation began, and Confort had to listen to the same cries that she’d tried so hard to settle over the past three years.

‘It pains me to hear her hurting, but I know it needs to happen,’ she said.

When the day finally came for Gamai to leave the ship, no one could have guessed she’d spent the majority of her life behind closed doors. Engaging and full of life, she leapt for joy as she played with her new-found friends — children that neither mocked her nor stared at her for being different.

Unable to lift her hands above her head before surgery, Gamai can now reach higher in life than she ever could before.