EPISODE 8: TAKING THE HELM
Dr Michelle White (anaesthetist and Deputy Chief Medical Officer) travels ‘upcountry’ to Lakossa to help train Beninese medics while Australian medic Nick Veltjens mentors local physiotherapist Melchior in the Ponseti method of treating club feet.
Featured patients include Howefassi – a woman with a large and complex neck tumour that tests surgeon Mark Shrime to his limits, Baby Joanes – a clubfoot patient treated by the Ponseti team, and Baby Riana – a girl with a rare disease called arthro-gryposis that can only be partially treated on the ship.
Continue reading below, learn about the patients and volunteers featured in this episode, plus explore ways you can be part of the Mercy Ships story too.
Houefassi is from a small, remote village in Benin where she lives with her children, her ageing parents and her extended family. Houefassi is from a very poor community and a lack of access to medical care has meant her tumour has been growing bigger each day for the last 15 years. Her tumour is one of the biggest Mercy Ships has encountered during their Benin service. Her specialist surgeon, Dr Mark Shrime, performs a CT scan which reveals the mass to be a set of separate tumours. ‘It’s the equivalent of about five grapefruits,’ he says.
Houefassi’s surgery is one of the riskiest procedures Dr Mark has performed. “It makes me question everything I know about anatomy,’ he says. The tumour is located in the neck and is intertwined with one of the internal jugular veins and the set of nerves that allow Houefassi to use her voice box and move her shoulder. If the jugular vein is accidentally severed Houefassi could bleed to death. If nerve damage occurs, she may lose the ability to move her right arm and use her voice. These are all risks Houefassi is willing to take.
‘Surgery is a chess game – it’s you against the tumour,’ he says.
Houefassi is in surgery for more than 9 hours and it’s with great relief that Dr Mark confirms he was able to remove the tumour. “That was an epic surgery. I’m tired but honestly, I’m happy that’s out. I’m happy with how well that went.” Through slow and careful work he was able to completely remove one of the jugular veins along with the tumour. He also removed the tumour from around her nerves, preserving her ability to move normally and speak.
Houefassi is now home in her village and beginning her new life without the weight of her nearly 2 kilogram tumour. To thank Mercy Ships for her surgery, she invited her three ward nurses to eat lunch with her family in her village – an experience each of them will never forget.
Riana is a quiet three month year old baby girl with an infectious smile. Wrapped up tightly in her mother’s arms, Riana seems content and happy. It’s only as she’s slowly unwrapped that a hugely complex medical case is revealed.
Baby Riana was born with a disorder that has caused her hands and feet grow inwards at a 180 degree angle. It’s a deformity that has serious consequences for her future. Without the mobility of her hands or feet it’s unlikely she’ll ever receive an education or be able to work. In a country with very little in the way of social services, Baby Riana faces a life of great struggle and poverty – as well as social isolation and ostracism that comes with extreme physical disfigurement.
Riana’s case is one of the most difficult the Mercy Ships team have ever encountered. Not only is her medical condition extremely complex, it brings significant emotional and ethical challenges to the team as well.
From Riana’s first consultation with Mercy Ships it’s unclear whether or not Baby Riana can be helped. Dr Lindsay Sheriff identifies abnormalities in her spine that indicate that even if the position of her feet could be corrected, she may not have the necessary nerves in place that would allow her to walk.
While the medics continue to explore options for Riana’s legs and feet, a decision is made to work on her hands. Australian physiotherapist Nick Veltjens and local Beninese physiotherapist Melchior Cakpo decide to admit her to the Ponseti clinic. Ponseti is a non-invasive method of changing the position of the hands over time with plaster casting. While it’s only small, after a few sessions there is visible change in the angle of Riana’s hands. This brings some hope to her mother and the volunteers.
‘It’s the difference between being a quadriplegic and a paraplegic,’ says volunteer physiotherapist, Desiree.
Improving Riana’s ability to use of her hands is a small step towards being able to live a better life.
But soon more information about Riana’s case comes to light. She is completely paralysed on one side of her body. Even with the improved angle of her left hand, she is unable to move it.
This paralysis, combined with abnormalities in her spine, lead the Mercy Ships team to decide not to operate on Riana. ‘Sometimes the wisdom is knowing when to treat and when not to treat. It’s hard to have a crystal ball and know,’ says hospital physician, Dr Lindsay Sherriff.
Mercy Ships volunteers inform Riana’s mother that her baby will never be able to walk. It’s difficult news to process and she is consoled by the chaplaincy team. The outcome of Riana’s case has an emotional impact on the Mercy Ships volunteers too. ‘It’s hard to say no and to say this is the end. We can’t help you anymore,” says Desiree, the physiotherapist who worked closely on Riana’s case.
To this day, Mercy Ships chaplaincy team continue to provide what support they can to Riana’s family.
MEET DR MARK SHRIME
Mark is a leader in the field of global surgery for poverty alleviation. At the time of filming, Mark is currently Clinical Instructor at Harvard Medical School, Associate Staff at Massachusetts Eye and Ear Infirmary & Staff Surgeon Mercy Ships.
He is a specialist ENT (ear, nose and throat) surgeon and a leading academic in the field of Global Health – which essentially means working out the best way to improve the medical and in his case particularly the surgical capacity and systems of developing nations. He’s served as Associate Professor and director of research in Global Health at Harvard Medical School.
Mark is very ambitious and passionate about the work Mercy Ships does. The latest research from WHO, Lancet Commission shows that improving access to affordable, safe and timely surgery is the best way to tackle the challenges of Global Health. That means Mercy Ships is where you want to be to make a difference on a practical level. On a policy level Mark is also very passionate about his work as a research academic. This is the time to be in Global Health. He’s on the verge of very big things, whichever way he chooses to go.
For his first several visits to the ship he worked as Dr Gary’s resident, and assisted in every surgery Dr Gary performed. This was the greatest learning experience he could have hoped for.
MEET Dr MICHELLE WHITE
Michelle is invaluable in the operating theatre, but she is also essential for bringing medical education to the countries they serve. “We serve the poorest of the poor and focus on the patient in front of us,” she says, “but we also work closely with governments to transform healthcare for the better.”
The British anaesthetist joined Mercy Ships on her first of six commitments onboard the Anastasis in December 2005, and her servant’s heart to the cause has been an inspiration. “Mercy Ships combined my love of the sea, love of people, love of travel and love of medicine” she explains.
Michelle then became Anesthesia Supervisor before developing the Capacity Building side of Mercy Ships’ operations. She was recently made Deputy Chief Medical Officer and her specialty is paediatric anaesthesia.
Michelle is leaving the ship in December 2016. She’s very sad to go. A much loved and valued crewmember. She has been a mentor to many people on board and is very highly regarded for her expertise. She’s leaving the ship to take on the Head of Anaesthesia role at Great Ormund Street in London, the UK’s premiere pediatric hospital. She’s leaving because this was such a great and prestigious offer, and one that takes her back to clinical practice rather than the Global Medicine and Capacity Building administrative roles she’s been doing of late.
This year the ship is also trialing a new way of screening remote patients via a smart phone application which allows the screening team to give feedback quickly to screeners in the field and better co-ordinate who should come to a remote screening – reducing the number of people presenting with conditions that the ship cannot help.
MEET NICK VELTJENS
Nick Veltjens is an Australian physiotherapist specialising in club foot correction, and particularly the Ponseti method. This non-invasive specialty treatment involves casting the foot in a series of casts that gradually guide the foot into the correct position. This works best with kids under 2 years old because they haven’t started walking so much yet and their bones are more malleable.
Nick also works with what are called ‘Neglected Club Foot’ patients; kids older than 2 who have often started walking on their clubfeet and agrivating them worse by doing so. Their bones heal more slowly but they can still be healed though may require surgery on top of treatment with Ponseti method.
Nick is also a mentor to local physiotherapists learning more about the Ponseti method. He spent months in France learning French so he can speak the language here in West Africa. He and his wife Susanne met on the ship in Guinea 2012 and married in 2014. Unfortunately he had a dramatic exit from Guinea when Ebola broke out and he was working in a small remote clinic in an area, which was affected.
His mentor on ship is Dr. Frank Hayden, chief Orthopedic Surgeon. Through Mercy Ships and Dr. Frank, Nick has been opened up to career development and discovery that he says he would probably never have found had he stayed in Brisbane, Australia.
MEET THE KIWI BEHIND THE SCENES
A lot goes on behind the scenes to make a Mercy Ship float, and that’s where Kiwis thrive. Maritime, operational and axillary medical departments support the on board operating theatres and four wards. Together this enables the hospital ship to be fully self-sufficient, providing state-of-the-art care in the most limited of local conditions.
Nathan Collis worked under the ship’s Chief Electrician in the engineering department. The Hillsborough man found his role so engaging he extended his original four-month tour of duty by eleven weeks, and then another six.
Approaching the end of his apprenticeship electrician Nathan Collis had a hankering to do some voluntary work overseas – something that involved using his industrial electrical skills. “I was going to be made redundant as Pacific Steel shut, so this seemed like a perfect opportunity to go,” explains the 23 year-old. The options seemed to be thin on the ground until he was captivated by a documentary about the hospital ship charity, Mercy Ships. “I felt that I could really be a part of something bigger,” explains Collis. “Seeing the excitement on those patients faces when they looked in the mirror for the first time (after their reconstructive surgery), made me excited for them. From there the thought grew. After seeing Mercy Ships needed an industrial electrician I talked to family, friends and prayed about it. It all felt right, so I applied.”
“My electrical experience has definitely increased from working on the Africa Mercy – from the generators and main engines to the oxygen generator for the hospital. I have worked in so many different areas of the ship, and have been able to pull so much knowledge from those I work with. The experience has definitely taught me not to care so much about things I used to think were a big deal.”
Nathan was deeply impacted on a very personal level by the larger work of Mercy Ships in their mission to provide essential surgical services to Africa’s poorest people.
“Getting to watch a cleft lip operation take place was definitely one of the most impacting moments for me. I was born with a cleft lip. Because I was fortunate enough to be born in New Zealand I don’t really have any memory of this, as it was fixed as soon as possible. This teenager had not been given that opportunity. He had gone through his life up being made fun of, and struggling to eat. An operation which takes a little over an hour changes someone’s life so radically.
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