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Rebooting the passion for nursing

New Zealand perioperative nurse Jude Quijano felt he needed to be inspired all over again about nursing and needed a reset.

“It felt like time for a reset,” Jude Quijano. “I had always wanted to volunteer for Mercy Ships, I just didn’t know when. I felt I needed reminding why I wanted to be a nurse. I was lacking the enthusiasm I once had for my job.”

I felt I needed reminding why I wanted to be a nurse. I was lacking the enthusiasm I once had for my job.” As a result, in June 2022 Jude signed up for a three-week tour of-duty in Senegal, West Africa, volunteering in the operating theatres on board the Mercy Ships vessel Africa Mercy. He was inspired by the end goal: Mercy Ships operates hospital ships in sub-Saharan Africa to increase access to safe, affordable and timely surgery for the 5 billion (Meara et al., 2015) people who usually have no pathway to obtain the treatment they need.

Senegal

Senegal, West Africa, has 70 physicians per million people and 38 per cent of the population live under the poverty line of two dollars per day. Senegal is ranked 164/188 on the UN development index. Mercy Ships typically spend ten months a year in a sub-Saharan African port to provide specialised surgical services and strengthen local medical capacity. Mercy Ships also help host nations identify areas of surgical need to direct policy implementation and practice.

Mercy Ships commit to each country for a five-year cycle:

• Two years of research, preparation and relationship building including governmental protocol;
• Ship docked in the nation for ten months, providing surgical and medical capacity building services;
• Two years of post-field service measurement, evaluation and reporting of the services provided with outcomes;

The launch of a second and larger hospital ship, Global Mercy, enables Mercy Ships to place even more emphasis on training. The new surgical vessel has been designed to allow a focus on  mentoring local healthcare workers to strengthen their healthcare system’s future by up skilling in  various specialities. Global Mercy begins 2023 with its first surgeries in Senegal, completing the field service begun pre and post-Covid-19 by the Africa Mercy. The new ship will then sail to Sierra Leone in August.

The same, but different

Jude said his biggest surprise was that there was a full, functioning hospital inside a ship. The 16,000 tonne Africa Mercy is similar in size to a New Zealand inter island ferry, with five operating theatres, bed capacity for 79 patients and an intensive care unit (ICU). Africa Mercy has all the allied health services required to provide a complete patient care package. During a typical 10-month field service, the surgical specialties are on rotation; orthopaedic, ophthalmic, maxillofacial, burns and plastics, women’s health and paediatric general surgery. Volunteers are scheduled for a few weeks or months at a time, depending on their medical, technical or general role on board. While Jude could have volunteered for as little as two weeks as a scrub nurse, his six-week stint
in Senegal gave him the opportunity to become familiar with the ship’s operating theatre routines. He felt he was making a real difference.

“I was part of the paediatric orthopaedic team during their operating weeks. We provided reconstructive surgery for children with severe bow-legs or knocked knees. My role was not that different from what I did at home. There were minor tweaks with the practice — for example,
when it came for the disposal of contaminated drapes, gowns and other consumable items used during surgery. To ensure nothing can be retrieved from landfill, cleaned and resold on the street, Mercy Ships has medical combustion facilities on board. Drapes and gowns are cut to ensure they can’t be reused. Contaminated sections were sent to the ship’s industrial medical incinerator, which leaves only sanitised dust as a waste product. It has very limited capacity and could only take a small rubbish bag at a time. The remaining safe portions would go through the normal rubbish process and be disposed in the landfill.

“There was one instance where I had to team lead because the team leader had to isolate for the morning pending the result of a PCR (Reverse Transcription Polymerase Chain Reaction) test for COVID-19. Because I had also done this at home, it wasn’t a big adjustment, just a matter of
following the protocols.”

Seeing the patient’s whole journey

“What made a mark on me was when the surgeons gave us updates on how the patients were feeling the day after the surgery. We operated on one maxillofacial patient for about three hours, excising a tumour on his mandible. I thought how sore he would feel post-op because of the
long procedure and large incision. There was some significant blood loss as well. Unfortunately, we were not able to visit patients in the wards because of Covid-19 protocols but the surgeon saw him the next day. He told us, ‘he is all smiles and putting two thumbs up!’ That was a very  gratifying moment.

“I think everyone plays a key role in order for Mercy Ships to be  successful in providing the service. I was part of something bigger than myself. It made me love my job more and I felt encouraged in the short time I was there. Being a theatre nurse on board feels like you are a major part of what Mercy Ships are doing — providing life-changing surgeries.

A professional and a personal impact

As well as the professional development opportunity experienced while working in the international hospital ship environment, many volunteers are quick to mention the personal impact of their service. Hearing about the personal, transformative effect surgery has on patients’ lives is not something that typically happens in the New Zealand healthcare context. Many Mercy Ships patients’ are excited to freely share their stories because of the radical difference the surgery has made for them and their families’ lives.

“Volunteering on board teaches you more about life in addition to the work experience that you get. You can’t help but appreciate what we have in our lives after being on board.”
Sira’s story: paediatric orthopaedic surgery “The orthopaedic reconstructive surgery that Sira had was not new to me but I had not assisted with this surgery for some time”, explained Jude.
“I was surprised at how fast it was and what a huge difference the half hour surgery would make to Sira’s life.”

Sira developed bowed legs when she was four years old, due to malnutrition. Her mother and father felt hopeless over the next two years as the distance between her knees continued to grow. They had hoped Sira’s legs would correct themselves. Living in Senegal, West Africa, Sira’s family didn’t have access to a physician who could diagnose the severity of her condition. Eventually they began looking for hospitals to help Sira — but the cost was prohibitive. Sira’s parents heard about Mercy Ships on the radio. It was an advertisement for orthopaedic appointments. They couldn’t leave their jobs and other children to take her to the Mercy Ships which was docked in the capital city so Sira’s grandmother travelled with her to the hospital ship for the reconstructive surgery which would straighten her legs.

When Sira took her first shaky steps next to her bed in the ship’s ward ost-op., her grandmother and biggest cheerleader said: “I will dance when she is able to walk from her bedside to the door”.
After several weeks of physiotherapy on board the Africa Mercy, Sira was discharged – and mobilising as she had only ever dreamed of. Sira can now run and play, she can walk the distance to school and is now able to access vital education. Sira’s options for the future have changed dramatically because of otherwise inaccessible surgery.

About Mercy Ships

For the last two decades global health has focused on individual  diseases while surgical care in low resource countries has not received  the attention it needed. Lack of surgical care has resulted in almost 17  million deaths annually.

Mercy Ships is an international faith-based organisation that operates hospital ships to deliver free, world-class healthcare services, medical capacity building and health system strengthening to those with little access to safe surgical care.

Since 1978 Mercy Ships has worked in more than 55 countries, with the last three decades focused entirely on partnering with African nations.

Each year volunteer professionals from more than 60 countries serve on board the world’s two largest non-governmental hospital ships, the Africa Mercy and the Global Mercy. Professionals such as surgeons, dentists, nurses, health trainers, cooks and engineers dedicate their
time and skills to the cause.

Mercy Ships has offices in 16 countries including New Zealand, and an Africa Bureau.

Volunteer roles for theatre nurses are now open for 2023. 

Published with permission by The Dissector magazine, and can be viewed online here 

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