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Leaving a sustainable dental care footprint

A unique perspective on providing sustainable dental care in Guinea, West Africa

Since 1978 the international hospital ship charity Mercy Ships has ‘hope and healing’ to the world’s forgotten poor by offering specialised surgeries, medical and dental training. Using the transportable platform of the 16,000 tonne Africa Mercy, the faith-based NGO spends 10 months at a time providing essential surgical and healthcare services to developing nations. The port city of Conakry was the hub of the NGO’s work for a fourth time, from August 2019 to June 2020.

“Mercy Ship runs on the goodwill of volunteers who give their time and skills to serve,” explains Dr Loo. “People from many nations, different cultures and languages all work together. It is a diverse community made up of incredible individuals. Many of these inspiring volunteers have dedicated years of their life away from home, foregoing a stable income and society’s mainstream definition of success.

“There were a number of factors that made practising dentistry vastly different than back home in New Zealand. The level of poverty, lack of education/awareness, lack of access to healthcare and medicine are a lot more significant in this part of the world. As a result we saw patients come in with enormous facial swellings that would have never been allowed to progress that far in New Zealand or another developed country.

“Due to the lack of access to antibiotics, dental abscess from an infected tooth could very well be a death sentence; a sad truth which is unheard of back home.

“Many of the patients with large untreated yet benign facial tumours had conditions which to developed large size, causing stigmatisation among their own community. They were inflicted with shame and some were outcast as a result.  These patients received free surgery on board the ship.

“Guinea is predominantly Muslim, with French widely spoken alongside a myriad of local languages. So during my days working at the dental clinic I would greet patients coming in or treatment in their local language of Fula, Onjarama (how are you?). I’ll never forget the delight on their faces when they heard the greeting in their own language.”

During the tour of duty in Guinea, parallel to patient care the Mercy Ships dental programme focused on empowering and enabling the local dental colleagues, a key way forward for the nation’s dental care system.

A CASE STUDY IN DENTAL SUSTAINABILITY – Dental Partner Unit Mentoring Programme

In addition to the Mercy Ships dental clinic which typically sees around 50 patients a day, a large dental project took place in partnership with Gamal Abdel Nasser University of Conakry.

Mentoring was provided over 10 months for thirteen dentists, dental school staff and a total of seventy-one dental students (45 men and 26 women).  The project included extensive renovations of the entire first floor of the dental school and the donation of the necessary dental equipment for the school to fully integrate clinical training into their curriculum for students.  The renovations and equipping allow the school to have an 8-chair student dental clinic, a 3-chair faculty dental clinic, a dental simulation lab, administrative offices for the dental school, and a dental laboratory.  To ensure that the equipment receives proper maintenance and repairs, our Biomedical Facilitator conducted an eight-day training course specifically for the donated equipment.

The medical capacity building courses sought to improve the sterile processing practices used by technicians in Guinea’s hospitals and clinics.  Twenty-two participants attended the Sterile Processing Course in Conakry.  Following the course, fifteen were selected for additional training-of-trainers in order to be better equipped to train others.

A nutritional agriculture course was conducted with 32 participants (26 men and 6 women) from five non-government organizations from seven regions of Guinea, who received train-the-trainer instruction in nutritionally based, biologically and ecologically sustainable agriculture.  The course included both classroom and hands-on instruction; training in food transformation and measures to respond effectively to climate change impacts on agricultural practice and output. After the 22 weeks of training, the new trainers returned home to set up their own agriculture training project.

The impact made in Guinea during that 10-month period included the training of 1,099 local participants in healthcare courses, the provision of more than 41,000 free dental procedures,  and 2,442 free essential surgeries in orthopaedic, maxilla-facial, burns and plastics, obstetric fistula, paediatric general and ophthalmic specialities.

Dr Loo’s most meaningful Mercy Ships experiences included some non-dental interactions outside the clinic. “During the weekends I had the opportunity to help at an orphanage; Hope Village. We spent the day making crafts, singing, dancing and sharing a meal with the children. I had opportunity to learn from the lady in charge of the orphanage who shared her experiences going through the recent Ebola crisis. It was heartbreaking to hear her account of the tragedy, and the loss of so many people. Their joy was inspiring despite the little they had and all they had endured in recent years. I was deeply impacted by her strength in overwhelming circumstances and her transparency in sharing her journey.’

Published with thanks to NZ Dental Association news, Dec 2019 

maritime, medical and general volunteer roles with Mercy Ships

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Mansare grew up with bowed legs — an ailment often caused by an underlying disease like rickets, and is worsened by malnutrition. The four-year-old had only known life with the orthopaedic condition which made walking and running an exhausting challenge.

After years of watching the small boy struggle with his limited mobility, Mansare’s family were excited to hear the news that treatment for his condition was being offered – for free.  Simone brought her son to the Mercy Ships screening day where approximately 6,000 others had gathered in hopes of receiving the help they needed.

From outside the gate Simone saw a large crowd and didn’t know if they would be able to get through. However, Mansare — plucky despite his young age — slipped through the gate and into the compound. He waved at her from the other side. “If you can’t get through, I will go and stand in line,” he called.

Once she got inside, Simone found Mansare standing in line by himself, unafraid, waving her over to join his spot. “He has always been brave like this,” she said.

This bravery hallmarked his time with Mercy Ships. After he received surgery Mansare spent weeks recovering and relearning how to walk. But even sitting in casts for several weeks couldn’t keep a smile from his face. After starting the physiotherapy program, Mansare was up and running.

Dashing around the dock, his frayed sandals flapping as he ran – and his laughter brought a smile to his mother’s face. “Look at him. Look at him walk,” Simone declared. “He can really play now. Before, he would get tired and come back after ten minutes because the other kids would laugh at him. Now, I have to go find him at the end of the day and bring him back home because he’s so happy to be out playing.”

The sight of an energetic little boy running and playing may not be remarkable to many, but it’s one that Mansare’s family has always hoped for.

“He loves his new body so much,” his mother said. But Mansare’s change goes much deeper than appearances. Now, it’s a challenge to keep him still, and his confidence and joy spill out into everything he does. Mansare seems like a new boy, inside and out!

Surgery has changed our life. He’s happier; I’m happier. He loves himself more. He’s more confident now!

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It’s easy to see Ibrahim’s joyful spirit. His adorable grin is absolutely infectious, but as soon as the one-year-old tries to stand up, his twisted feet become evident.

His mother, Salimatou, noticed that something was wrong with Ibrahim’s feet as soon as he was born. Both of his feet were bent inwards, a condition which only worsened as Ibrahim grew. Once he began crawling and eventually attempted to walk, Salimatou’s fears grew stronger. She soon realised that something was wrong with her child — something she had no way to fix.

Ibrahim is the youngest of five boys, all of whom keep Salimatou on her feet from dawn to dusk. In order to keep Ibrahim safe, Salimatou would often keep him in a sling on her back, but, she knew that this wouldn’t work as he grew older. With his ability to walk becoming increasingly limited, Ibrahim was facing a future full of difficulties and few options.

One day, Salimatou and her husband heard a radio announcement about a hospital ship that would be sailing into Guinea. After travelling to the Africa Mercy, Ibrahim and his family were hopeful that this would be their chance to find healing for his legs.

Ibrahim was welcomed into the Mercy Ships Ponseti clinic and was soon undergoing treatment to heal his clubfoot. He spent seven weeks in casts, which gently manipulated his feet into a normal position, before undergoing a simple surgery to snip a tendon in his ankles. Afterwards, he was recast and given several more weeks to heal.

Halfway through Ibrahim’s treatment, his mother said, “I can see the difference in his feet already. His feet are getting straighter each week — we can all see it! It makes us so happy.”

While his time in casts was over after leaving the ship, Ibrahim still has some work to do before he is fully healed. He will continue to wear a nighttime brace for years, to ensure his feet stay straight, much like wearing a retainer after having braces removed.

The simplicity of Ibrahim’s treatment is encouraging for other children suffering from clubfoot. The Ponseti treatment doesn’t require a state-of-the-art operating room or cutting edge surgical equipment, but instead relies on time, plaster, patience, and proper training.

Clubfoot program manager Aisling Russell from the UK has brought several local Guinean medical professionals alongside their team throughout the Ponseti process. By providing local hands-on training and letting them be a part of every step of the journey, the Mercy Ships Ponseti team hopes that these locals will be able to continue treating children with clubfoot in Guinea long after the ship sails away.

You don’t have to look far to see the effects that this training is having. Mercy Ships was based in Cameroon the previous year, where the Ponseti team ran similar mentorship programs with local professionals. This year, they brought back a familiar face to lead Ibrahim’s tenotomy procedure: Dr Faustin Atemkeng Tsatedem, a Cameroonian orthopaedic surgeon who received this training during the last field service. He visited Guinea several times to assist with surgeries like Ibrahim’s and to help train a new batch of medical professionals.

“The Ponseti Method of treating clubfoot is the gold standard treatment method used worldwide. Children who complete treatment are then free from deformity and a life of disability,” said Aisling. “In the context of Guinea, this is even more poignant as there is a misunderstanding about the cause of physical deformities that brings shame and limited opportunities for work and marriage. The transformation is obvious, but the lifelong impact is that these children then have a chance to live a life free of shame and the opportunity to work and input to their community.”

He’ll be able to walk like other boys when he grows up. It makes me so happy to see him like this.

Ibrahim is so young that he won’t remember life before his Ponseti treatment. He’ll grow up with feet that carry him where he wants to go, with the only remnant of a former life being the brace he wears at night for the next several years — but his mother will never forget.

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Amadou refused to be defined by the tumour that had been growing on his face for more than 15 years. To those in his community, 46-year-old Amadou is a doctor, a leader, and a pillar of hope.

Medicine was a clear path for Amadou, who had been a practise nurse for over 20 years, fulfilling his desire to help others. But over the years, his own health deteriorated as he developed a Pleomorphic tumour in his salivary gland that grew slowly and steadily on the side of his face. But his condition did not stop him from caring for his patients.

“I did not ever tell myself ‘because you have this tumour you cannot help others’ — that would not be fair to them,” Amadou said. “Instead, I told myself that I should still try my best to help those around me so that God would help me in return.”

Amadou knew that his own local hospital was not equipped to perform the surgery needed to remove his tumour, so he began to save money in the hopes that he might one day be able to travel to the capital. He hoped he would find help in removing the mass on his face.

One day, as Amadou sat in his clinic, people from his village came rushing in to tell him some exciting news. The man who spent his days helping others might finally be able to find help for himself onboard a hospital ship docked in Conakry, Guinea.

“When I heard about the ship, I was the happiest man,” Amadou said. “I thought, if I get this surgery, I will be a patient ambassador and tell the world about Mercy Ships!”

Amadou made his way to the Africa Mercy to receive the help he needed to continue saving others. After a successful surgery onboard by volunteer medical professionals, Amadou was cleared to go home. Upon his return, it became abundantly clear just how much he meant to his community, as hundreds gathered for his arrival. People dancing and singing lined the streets in celebration as his friends and family welcomed back their well-loved doctor.

“I cannot even begin to describe what this community means to me and how much I love them,” Amadou said. “I believe I love them even more than they seem to love me!”

The story of his healing travelled through his community and soon reached another in need. Soon after he’d returned home, a 37-year-old woman came into this clinic with a cleft lip. Immediately, Amadou travelled for over a day to bring her to nurses from the Africa Mercy, enabling her to receive the same life-changing surgery that he himself had found two months earlier.

Whilst at the ship I learned how they take care of their patients. I want to bring this [knowledge] back to my own clinic.

While waiting for the woman’s recovery, Amadou used his time to tell patients who were waiting for surgery that everything would be okay — that he was a walking testimony of the safe surgery performed on the ship. True to his word, Amadou became the advocate that he promised he’d be!

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Moussa in his village before surgery.

Moussa’s village seems like it’s on the edge of the world. To reach the nearest large town requires passing through dry underbrush on foot or by motorcycle, crossing a river by canoe, and driving for hours down winding dirt roads.

When his condition first began as the result of an untreated dental complication, Moussa realised that it wasn’t going to go away on its own. He felt helpless. With surgical care costing far more than the rice farmer could afford, he could only use traditional medicine — and pray.

But, when Moussa heard over the radio that Mercy Ships would be hosting a patient selection screening the next day, he immediately left his village and travelled through the night for a chance to be seen by the medical team.

The fifty-five-year-old had lived with the fear for six years. He was terrified the tumour in his mouth wouldn’t stop growing, and he was prepared to journey any distance to be free from it. As the growth developed, Moussa found it increasingly hard to eat, speak, and work. He stopped labouring in the rice fields, leaving his nephew to take the mantle as the provider of the family. Over time, Moussa — once a proud and enigmatic leader in his village — began to feel ashamed of how he looked. He covered his face with a shawl to hid the tumour and kept his eyes downcast. He stopped sharing meals with his family, instead choosing to eat in a separate room so no one would see him struggle to eat.

For Moussa, hours of travel and standing in line were nothing compared to the hope that he might have a chance for a brighter future. When he was told he was eligible to receive surgery, even the daylong bus ride to the port city where the Africa Mercy was docked couldn’t keep Moussa’s joy at bay.

After arriving onboard, Moussa’s tumour was removed and he spent the next several weeks being cared for by nurses as he recovered – from his surgical wound and his emotional scars. During his time onboard the Africa Mercy, he was welcomed into a community and loved by strangers, causing him to slowly step beyond the emotional walls he’d built around himself.

As he began to come out of his shell, his true self emerged. Moussa returned to his village once again confident and proud to see his community. He was celebrated by a crowd reverberating with dancing, singing, and laughter.

‘I feel like a president,’ Moussa said as he shook hands with everyone in sight.

Being welcomed back into his community and once again sharing a meal with his family, Moussa feels his life has changed in more ways than one.
“I would surely have died if not for this surgery,” he said. “I’m very grateful!”

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Saliou was too young to realize that he was different. At 2 years old, the little boy had no idea that his cleft lip set him apart from the other children. Blissfully unaware, the condition had no damper on Saliou’s personality, which brought joy to everyone he met.

While some might view Saliou’s condition as a reason to feel shame, especially in West Africa, where the lack of medical access can cause a person to live with the defect for a lifetime, Saliou’s grandmother, Ndiane refused to let his condition hinder her love.

“He’s so handsome,” she said while holding his photo.

Despite her admiration for Saliou, Ndiane still hoped that he wouldn’t have to grow up with a cleft lip which, she worried would cause him to become an outcast when he was older.

“If he didn’t get surgery, he would be different from the other children,” she said.

Unfortunately, Saliou’s family didn’t have the means to find healing for him. With very minimal access to safe, affordable surgery, Ndiane resorted to the only thing she could do — she prayed for a miracle. She held on to the hope that one day, her sweet Saliou would be healed.

After two years of waiting on a miracle, Ndiane was thrilled to hear about a hospital ship that was docked in the capital city of Senegal. This devoted grandmother traveled 12 hours to bring Saliou to the Africa Mercy for a surgery that would change his life forever.

“When I heard about the ship’s arrival, I was relieved,” she said. “Then, I made the decision to stop everything and bring him because this will impact his future!”

Ndaine’s heart swelled with joy and gratitude after Saliou’s operation — her grandson was finally healed! Now the young boy’s future looks brighter than ever.

“I’m giving thanks to God and the people at Mercy Ships. I didn’t have anywhere to get surgery for Saliou, and they did that for me.”

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‘It has hands down been the best thing I have ever done,’ Lauren concludes as she reflects on her three months onboard the world’s largest civilian hospital ship, Africa Mercy, currently docked in Senegal, West Africa. The Morrinsville the occupational therapist’s professional skills were stretched to the limit as she worked in the Mercy Ships rehabilitation team.

Fellow Kiwi nurse Bec with Mohammed and Lauren

‘I went to the Mercy Ship to assist with hand therapy, but I have left with so much more than I could ever imagine,’ Lauren enthusiastically explains. ‘I was challenged professionally with conditions I had never seen. My entire caseload consisted of children, which was incredible, but also extremely difficult as I don’t generally work with children at home.’

Lauren’s years of work at Thames and Waikato hospitals in the hand therapy, and burns and scar management department prepared her for the extreme cases she would encounter in West Africa. Her skill set is vital to the successful outcome for the hospital ship’s patients who undergo operations onboard after their third-degree burns were untreated. In the developing nations Mercy Ships serves, there is little access to medical services; when accidents happen people often suffer life-long consequences. If a severe burn heals without medical care, scar tissue will form and immobilise the joint, permanently disabling the sufferer.

Free surgery to release the scars provides half the answer. Lauren and the rehabilitation team then work with the patients post-surgery to help them regain basic function; to walk normally, to hold a spoon, and even lift their arms above their heads – often for the first time in many years. Only then is complete healing within reach.

Lauren explains the life-long impact of the injuries and scaring for her plastic surgery patients. ‘Most of our patients had burn contractures to their hands, elbows or arm pits from a very young age, as young as two days old. They have had contracting scars for 3-20 years and had adapted to this way of life. They altered their motor patterns so they could function in everyday life.’

Lauren made enduring friendships during her volunteer service on the hospital ship

The 24-year-old was so impacted by her tour-of-duty that she has signed up to return in February for another four-month volunteer service. Lauren feels she grew personally as well as professionally as part of the international crew, ‘I was able to build relationships with patients, crew members and day crew that are so rich. I made new friends, was immersed in African culture, and learned a new language (very little, but enough to get by and have my patients excited that I would try). I was challenged spiritually in my beliefs, my reason. I was shown that love and people are more important than anything else. I went to Senegal for work, but I left with a richness to life that I will cherish forever.’

Mercy Ships spends 10 months each year in a West African nation providing free essential surgery for people living in in extreme hardship, and is crewed by medical, maritime and general volunteers from around the world.

‘Mohammed loves a hand hold and his favourite English word is Loz. He hates smiling at the camera. He loves his exercises the most of all of my patients, and will me and join everyone else’s treatment sessions as well as his own. He reminds his mum when it’s exercise time.

Video: Watch Gamai’s story

 

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KADIATOU’S DOUBLE BLESSING

 

Like Mums the world over, when her daughter was hurting M’Mahawa did all in her power to comfort her and make life that little bit easier. In the midst of so many other challenges in their lives, she helped Kadiatou take a step towards being like the other little girls and developed a unique way of putting shoes on her five-year-old daughter.

Yes see, Kadiatou was born with bilateral club foot — her little hands were twisted too. So Kadiatou’s mum would sit every day with her fragile daughter on her lap, tying sandals to the little girl’s feet with string and complicated knots so they wouldn’t slip right off Kadiatou’s tiny twisted feet.

 

 

 

 

Because there was no treatment available for her feet when she was born, now they were twisted almost beyond recognition. This condition meant Kadiatou walked on the top of her feet.

And that was so far beyond her family’s reach to fix. They desperately needed help with Kadiatou’s condition but had no idea where to find it. That’s where you come in!

Without the ability to wear shoes correctly, Kadiatou suffered from the extreme elements found in West Africa. She had constantly wet feet during the rainy season, and cracked and sore skin during the dry season. She was often in pain, but her heart hurt as well. You see, her condition also caused her to fall behind her friends.

 

 

‘She’s as energetic as her brothers and sisters but cannot do as much,’ her mother explains. ‘She cannot walk far without cutting herself.’

‘I HAVE PEACE ABOUT THE FUTURE. SHE WILL HAVE BETTER OPPORTUNITIES IN LIFE NOW THAT SHE WILL NOT BE AN OUTCAST.’

 

M’Mahawa saw an alert on her phone that explained Mercy Ships was offering free surgeries for conditions like Kadiatou’s. it seemed almost too good to be true.

Amazingly, just eight months after her first Mercy Ships appointment, Kadiatou could walk confidently and correctly on her feet. She is no longer fearful of being hurt with cuts and scrapes.

Kadiatou may not fully remember every aspect of her physical struggle and the reason for her surgery on the ship, but every day as she ties her shoelaces she will be reminded of the never-ending gift of healing that you helped deliver.

 

Thank you for remembering these families in desperate need. Your donation means the world to them!

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VIDEO: It looked like a boot on Tene’s leg – but it wasn’t. When she was still in the womb, a band of tissue wrapped around her leg. As Tene grew, so did the swelling. They couldn’t find anyone with the surgical skills who would help them, and her mother despaired.

But thanks to friends like you, free surgery on the Mercy Ship turned Tene’s clunky gait into the happy skip of a typical three-year-old. Watch Tene’s inspiring story now