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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.

Building medical capacity is a key strategy

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 Royston, senior biotech on the Mercy Ship

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.

Tony with his wife Patricia (a chaplain) and Elliot (a school student) lives onboard for a decade

‘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 EngineersInternational Federation of Health Engineers, and HealthCare Facilities magazines for publishing this article

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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

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There is nothing more heartbreaking for a parent than watching their child struggle through basic tasks because of something they can’t control. Ibrahima knows this pain well, from watching not one, but two of his children suffer from an orthopaedic condition known as Genu Varum or bowed legs. This malady, often a result of malnutrition, causes the bones in the legs to bend outwards — making it increasingly difficult and even painful to walk.

For years, Ibrahima prayed for a way to take away his children’s pain, and in 2012 he heard the news that he so desperately needed. Mercy Ships had arrived in Guinea offering to provide safe and free medical care to those in need. During that time, he was able to bring his older son to the Africa Mercy to correct his legs — an answered prayer for Ibrahima.

Unfortunately, for his younger daughter, N’nady, healing was still out of reach. At the time, she was staying with relatives in a remote village deep in the rugged country and wasn’t able to travel to the ship in time for surgery.

Years passed, and while he was grateful for his son’s healing, Ibrahima felt both grief and guilt that he wasn’t able to provide the same for his daughter.

N’nady continued to struggle with her condition, and soon her pain became more than physical. N’nady was teased relentlessly and the mockery she faced caused

Ibrahima even more distress. ‘I fight for her every day. I tell the other kids off for making her cry,’ he said. ‘Everyone teases her.’

While it was difficult to see his daughter in pain, he never gave up hope that the ship would return and that N’nady would have a chance for healing. Six years later, the Africa Mercy returned to Guinea, and N’nady’s family rejoiced.

‘I’m so happy I can’t even eat… I’m so excited to see her healed,’ Ibrahima exclaimed.

The enthusiasm he felt must have been contagious because, after surgery, N’nady shot through her recovery at lightning speed tackling her rehab exercises with the same sweet, shy smile she always wore.

Emma, a physiotherapist from Havelock North, worked closely with N’Nady during her rehabilitation and says, ‘N’nady was a quiet achiever. She did all of her exercises with determination and grace and never gave up. N’nady also loved a hug or was quick with a smile, but when she came to rehab she was there to work and nothing was too difficult. I loved working with her.’

By the time N’Nady and her Dad left the ship to return home, many weeks had passed, yet Ibrahima looked years younger, sharing his overwhelming gratitude.

‘I am forever thankful to have two children healed on Mercy Ships,’ he said. ‘It has changed my family, and changed my life.’

Now, with N’nady’s legs straightened, it is easier for her to walk without being in pain or mocked. N’nady and her father both agree that she’ll be going back to school as soon as possible — although they have different opinions about what comes next. Ibrahima dreams of his daughter becoming a doctor, but N’nady dreams of one day becoming a tailor and making dresses. Whatever she becomes, N’Nady finds joy in knowing that her options are wider than ever.

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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.’

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Her mobility was severely compromised by the burns scars on her arms

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.’

Gamai on the ward after surgery.

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.

Gamai during one of her physiotherapy sessions.

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.

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Adama was five months pregnant when the world around her started to flicker and fade. 

Because of cataracts in her eyes, soon all she could see were shadows and shapes. Months passed as her vision continued to dwindle. ‘Maybe it will clear up after I give birth,’ she told herself, hoping that the loss of sight was somehow linked to her pregnancy.But once she’d delivered her twin babies — a boy and a girl — 30-year-old Adama had to face the truth. She was blind and afraid that she might never be able to see the faces of her newborns. And without access to affordable, safe surgery, she felt like there was nothing that could fix her sight.

‘I held my babies after they were born, and I couldn’t see their faces. I thought this would last forever; that I would never know what they look like. I was very desperate,’ Adama said. ‘I didn’t have any hope.’

Adama, along with her newborns and four other children, moved in with her older sister, Aissatou, who became their caretaker. Aissatou welcomed them in lovingly, but with her own children to take care of, the burden was heavy. ‘It’s been a very hard year,’ Aissatou reflected in tears.

For Adama, the reliance on her sister was challenging in a different way. The sudden inability to take care of her own children left her feeling guilty. ‘Since my eyes are dark, I can’t walk alone, go to the market, cook, do laundry… I can’t do anything without help.’

Adama’s blindness stretched on for almost a year. The twins were six months old, their faces still a mystery to their mother, when her husband first heard about Mercy Ships.

For this family, the opportunity to access a state-of-the-art hospital ship meant more than just free surgery. It meant giving Adama the chance to step out of the darkness. It meant being able to take care of her family instead of depending on others for help. It meant being able to see her loved ones again.

It meant hope.

The day after her operation on the Africa Mercy, Adama sat on a wooden bench waiting for her eye patch to be removed. It was the moment she’d learn whether or not her eyesight had returned fully.

As the patch was peeled back, Adama kept her eyes closed for a few moments. Gradually, she blinked them open. A smile slowly spread across her face as she realized she was seeing the world again for the first time in almost a year.

Her family members, gathered nearby, were some of the first people to welcome Adama back into the world of the seeing. She walked by herself to greet them, no guiding hand needed. ‘When I die and will go to paradise and meet my own people there… that’s what the moment was like.’

She reached for her twins, drinking in the details of their faces for the first time. Tiny noses; long eyelashes; round cheeks — Adama cradled them both in her arms at the same time, eyes dancing between the two.

‘I never expected that my babies would be so beautiful,’ she murmured.

The impact of her restored sight will reverberate throughout the rest of her life. There will likely be countless moments where Adama rejoices because of the ability to see again — but it’s hard to imagine a moment more meaningful than a mother’s patient love being rewarded with the sight of her children for the first time.

Written by: Rose Talbot

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British Journal of Surgery (BJS) has published an important medical paper about the work of Mercy Ships. The paper is an evaluation of our implementation of the WHO’s Surgical Safety Checklist in Benin in 2016/17,  co-authored by Mercy Ships expert Dr Michelle White of Great Ormond Street Hospital, and Dr Nina Capo-Chichi, a surgeon in Benin,

The Checklist is a simple tool that has been repeatedly shown to improve surgical outcomes and reduce mortality and morbidity.

‘One of the greatest challenges we face in tackling this problem is how to take proven interventions, and implement them successfully, at scale in low-income settings.’ Dr Michelle White.

In Benin, Mercy Ships volunteer experts visited 36 hospitals and delivered three days of multidisciplinary checklist training at each site, teaching medical staff how to use the Checklist. The aim was to see how great an effect Mercy Ships could have by running intensive courses in Checklist training across a whole country, rather than spending six to 12 months in a single hospital. Would the healthcare providers still be using the Checklist up to four months later?

‘We found that checklist use increased from 31% pre-training to 89% at four months and this was sustained at 86% 12-18 months later. Also after 12-18 months, there was high fidelity use and high penetration shown by an improvement in hospital safety culture.’ Dr Nina Capo-Chichi.

This evaluation, published in the BJS, forms part of the ongoing assessment of Mercy Ships field services in Benin. Assessing our work in this way enables us to improve the delivery of our projects and connect our work to tangible outcomes and impact subsequent field services; offer better healthcare strategy advice to host nations’ governments, and provide information to other non-governmental organisations working in low and middle-income countries.

The paper also stands with a growing body of work led by female medics and jointly with professionals in both Western and Sub-Saharan Africa – a hallmark of the innovative and collaborative approach Mercy Ships is proud to promote.

See a video summary and read the full paper ‘Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist’

‘Leaving a legacy of lasting change is crucial, so in addition to providing direct medical care on our hospital ship during a ten-month field service, Mercy Ships implements a programme focused on health system-strengthening and quality improvement across the whole country, with the goal of improving the medical care provided for generations to come,’ stated Dr Peter Linz, International Chief Medical Officer at Mercy Ships.

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Captain John Borrow taking a navigational fix during the sail.

John Borrow never planned on being a full-time volunteer, but when he first heard about Mercy Ships in the 1990’s he knew it was an opportunity he couldn’t ignore.His long journey with the not-for-profit that operates the world’s largest civilian hospital ship, Africa Mercy, has taken Mr Borrow and his family from Sydney around the world. From 2016 to 2018 he served as the flagship’s Captain.

More than 400 volunteers from over 40 nations live and work on board the Mercy Ship, providing free surgical essential services and health care education to those without access in the developing world.

Borrow learnt of Mercy Ships through a friend. After setting foot on board during a visit while a ship was in port in New South Wales, he knew he wanted to be part of its crew.

‘I was kind of disillusioned with my sea career,’ Captain Borrow recalls. ‘I went up to check out the ship and I was pretty excited. I kept thinking that I had found my thing; I found my calling.’

Joining the Mercy Ship as Third Officer, Borrow travelled to Papua New Guinea on a three-month assignment and was enthralled by the experience. After hearing about the trip, his partner Lee-Anne, who was a dietitian and had just finished her master’s degree in nutrition, was also eager to join.

Borrow Family in front of the funnel

After the couple married in 2001, they boarded the now-retired Caribbean Mercy, where Borrow volunteered as Chief Officer before moving on to the original Mercy Ship, Anastasis, in 2005, where the couple raised their first son for the first 18 months of his life.

Eventually ,they returned to Australia to have their second son. After 8 years of being at home and working ashore Borrow knew it was time to return to Mercy Ships. 

The Borrow family joined the current flagship, Africa Mercy, in Madagascar in 2015, allowing John to claim that he’s been the Chief Officer on every Mercy Ship except for one.

He took over as Captain in August 2016 and three years’ service took the family to Benin, Cameroon and Guinea. Lee-Anne used her professional skills in the Mercy Ships Infant Feeding Programme while their boys attended the onboard school for crew children. In each port Lee-Anne worked with the Mums of severely underweight babies. These infants with cleft palates require additional nutrition so they would be strong enough to undergo plastic surgery to reconstruct their clefts.

Captain Borrow and his family have now returned home, leaving a vacancy in his role.

‘We are struggling right now to find long term Deck Officers, especially Chief Officers and Captains. These roles are not only critical for the safe operation of the ship, but also to lead our deck crew, which are mostly Africans and the nicest, most gentle, respectful bunch of people you’re ever likely to meet.’

‘Our three years on board the Africa Mercy has been an amazing experience and we’ve met some truly inspiring people here, all with the same goal to help those not as lucky as we are. Once you see this level of pain and suffering you cannot be unaffected. You cannot ignore it, something changes, and you have to help.’

Captain John Borrow and Dietitian Lee-Anne Borrow

Thanks to Professional Skipper magazine for publishing this story

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When M’Mah was born, her mother had a simple wish for her daughter’s life. ‘I want her to be like a diamond — to shine bright,’ she said.

Unfortunately for most of M’Mah’s life, the light inside her was overshadowed by the neurofibroma growing on her face.

When she was just a baby, her parents noticed a small lump and dark hairs growing above her left eye. By the time she was five years old, M’Mah’s neurofibroma was drooping over her forehead like a sac and beginning to dislocate her eye.

Over time, more lumps started to develop on her skull and upper lip, causing severe swelling. Even at her young age, other kids noticed M’Mah’s differences, which led to bullying and name-calling. They would call her ‘sick’ and avoid playing with her because they were afraid of her.

As a result, she was spending her childhood on the sidelines. She refused to go to school, even though her parents desperately wanted her to have an education. ‘She was so scared… she said everybody would laugh at her,’ said M’Mah’s mother.

With a heavy shroud of insecurity and fear surrounding M’Mah, it was hard to see the sweet, playful girl inside, waiting to be let out.

The family was poor and struggled to provide enough food for their two children, so an expensive, complicated surgery was out of the question. Her parents prayed every day for healing for their daughter.

When they heard about Mercy Ships, M’Mah’s mother was overjoyed. It was the first time that she’d dared to believe her daughter might receive surgery. The family travelled for hours to get to the Africa Mercy, but the end goal was worth every arduous mile.

Soon, a volunteer plastic surgeon specialising in neurofibromas removed the tumour M’Mah had carried for years.

Receptionist Esther Harrington with M-Mah

In the weeks following her operation, M’Mah spent time on board being showered in love and friendship by the nurses, crew and other patients. Esther from Taupo spent many hours playing with the little girl to help her pass away the hours as she recovered from her massive surgery. Freed from worry, the sweet five-year-old slowly emerged from her shell, and her inner diamond began ‘to shine through.

Esther says that on days when I couldn’t make it down to the hospital to play with her, M’Mah asked the translators where her special friend was.

‘One day I went to the hospital just to cuddle her because she was having a bad day. Things were sore, and she was tired. My heart broke as I held her, listening to her deep sobs, and feeling her tears on my arm. But she knew she was safe there. We sat in our own little bubble, and that was enough. I’ve learnt so much about courage and bravery from these little warriors.’

Thanks to her growing confidence, M’Mah is no longer afraid to start school and will begin her education next year.

‘When we came to the ship for the first time, I was just thanking God over and over,’ said M’Mah’s mother. ‘There is no gift greater than good health.’

Written by: Rose Talbot

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Sign up to be the first notified of the broadcast date of TVNZ’s SUNDAY feature, recently filmed onboard the Africa Mercy in Guinea

Watch here for broadcast details of the SUNDAY Mercy Ships feature, due to air early in 2019.

Miriama Kamo and TVNZ’s SUNDAY team present a weekly in-depth current affairs, bringing viewers award-winning investigations into the stories that matter.

They are kicking off 2019 with a special filmed on board the Mercy Ship in Conakry, Guinea. Producer Chris Cooke, reporter Tania Page and videographer Gary Hopper had the experience of a lifetime as they followed the journey of a dozen Kiwis volunteering on the Africa Mercy, and met the courageous patients receiving free essential surgery onboard.

Why not receive a notification of the TVNZ free-to-air programme airdate by joining Mercy Ships NZ’s monthly EDM (you can unsubscribe at any time), and then you can plan to have a few friends over to watch along with you!