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 the 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 more than 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 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