Medical Capacity Building (Demo)

LISTEN ONLINE to RNZ’s Nine to Noon interviews nurse Deb Adesanya about the special bond speaking the local dialect gave when interfacing with her patients, and other remarkable aspects of her five-month voluntary service on the Mercy Ship.

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Vivien and Manatiry developed a special bond
Vivien and Mananatiry developed a special bond

Starship Health paediatric nurse Vivien Welsh always knew she wanted to work with children. She entertained both teaching and nursing as career options. But time with a Christian missionary organisation based in Brisbane and travelling in India and other parts of Asia convinced her nursing was the right choice. “When I was travelling, I saw just how much need there was for health care.”

Her first paediatric placement as a student and her pre-registration placement on a neurology ward at Starship confirmed she had made the right career decision. She graduated from Auckland University of Technology in 2012 and began her nurse-entry-to-practice placement on the neurology ward where she had worked as a third-year student. Welch loves the work.

“I love working very closely with families. It is different to working with families of adult patients. When a child is in hospital, a family member is there all the time and every shift we discuss with that family member what we hope to achieve. It is a real partnership.”

She has stayed on the neurology ward – “there’s still so much to learn”. But her time there has been punctuated by two stints as a volunteer nurse with Africa Mercy, the world’s largest civilian floating hospital, which was in Madagascar. The Africa Mercy is run by the international non-government organisation Mercy Ships. The first time – from mid October 2014 to mid-January 2015 – she worked on the ship’s paediatric ward. She resigned from her job to do so, but on her return successfully applied for a position on her former ward. Welch knew she wanted to return to Africa Mercy. For her second assignment of 12 weeks with the hospital’s dedicated wound care team, which began in early January this year, the ward accommodated her unpaid leave.

She feels compelled to do this work. “I want to make a practical difference and Mercy Ships provides the structure and support to do that. I also feel a responsibility to do so. I’ve been born in this country but have done nothing to deserve that fate; I could just as easily have been born in a country with nothing. I feel I have a duty to give something back.”

Six-year old Manantiry's arm and hand were immobilised by scar tissue
Six-year old Manantiry’s arm and hand were immobilised by scar tissue

Time with the dedicated wound care team was her way of doing so this year. “Working on the ‘dressings team’ was very different to any nursing I’d ever done before. Previously, I’d worked on the wards where I had a patient load. In the ship’s dressing team we definitely worked as a team, which was great. Five of us rotated, with four nurses on duty each day. We operated in pairs, alternating between performing dressing changes and distracting kids, while getting the instruments and dressings ready for the other nurses.”

There was always music playing, and dancing withher bandaged patients to Taylor Swift’s latest hit was a regular occurrence.

“Despite the seriousness of the conditions being treated, we created a fun environment to work in. There was always music playing. We sang and danced around with our patients – or solo – to entertain them! We always ended the day with our faces covered in stickers from the kids.”

A six-year-old boy, Manantiry, will always remain in Welch’s memory. He had pulled a pot of boiling water onto himself when he was two. His family lived in a remote village, had very little money and poor access to health care. She first met him during his initial dressing change one week after surgery on board. (See box on facing page.)

“He had  severe burn contractures and surgery released his scarring and he received multiple skin grafts. Dressings had to be changed on four different sites: his hand, axilla, elbow and the large donor site on his thigh.

“I had the job of distracting Manantiry and holding him still, while his surgeon did the first dressing change. It is something I will never forget. Manantiry screamed and screamed for most of the hour that it took.  I spent the entire time wrapping him in a hug and holding his arm or hand still for the surgeon. Manantiry stared directly up at me with his huge brown eyes. I spoke to him gently, reassured him, and sang to him. Through it all, I think Manantiry ended up trusting me more. For weeks afterwards, I was the only one he would allow to perform his dressing change. We formed a really strong bond. It was amazing to watch some of the movement in his hand restored soon after surgery.”

The basics of dressing changes

As her 12-week assignment was coming to an end, Welch was working in the ship’s dockside clinic doing outpatients’ dressing changes. Manantiry’s mother came to the clinic and told her they were going home, as a family member had died. The journey back to their small village took five or six days of difficult travelling. “She said they would return in a month because it would take that long to travel there and back. We quickly taught Mama the basics of changing the dressing and looking after her son’s wound. Before he left, he had 90 degrees of movement at his axilla.”

Welch later heard that Manantiry had returned to the Hospital Outpatient Extension Centre about three weeks after they were scheduled to arrive. His wounds had all healed but he had lost some range of movement because he hadn’t been doing his exercises. The rehabilitation team continued to work with him to regain that lost movement.

While Welch saw “crazy surgical presentations I’d never see in New Zealand”, the actual nursing practice on Mercy Africa was more akin to caring for elective surgery patients. “The nursing is not as acute as my nursing here – you’re not run off your feet so you can get to know the patients and their families really well. We could spend time hanging out with the kids, singing, playing, forming real relationships and seeing how much of a difference we can make. I loved that about it  and I certainly got more than I gave.”

Returning to New Zealand and re-entering a high-acuity environment, with acutely unwell children, takes a little adjusting to. But what she finds more of a challenge is some people’s attitudes. “All our patients have really nice single rooms but some people can still find things to complain about. They don’t realise how good we’ve got it here. We have access to free health care. In Madagascar, every intravenous line, bag of fluids, dressing pack etc must be paid for before you get any treatment. If you don’t have money, you don’t get help.”

Welch wants to continue making a practical difference. “I think perhaps it’s time to move on from the neurology ward and get some different experiences, keep challenging myself to learn new things and get new skills I can take overseas. I want to keep finding ways of working overseas, to keep learning and to keep becoming a better nurse.”

Published by Kai Tiaki, Nursing New Zealand December 2016. Posted with permission.

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Dr Hadleigh Reid's second tour-of-duty
Dr Hadleigh Reid’s second tour-of-duty

It is becoming a habit for Dr Hadleigh Reid to spend his down-time overseas – providing free dental treatment for some of the world’s poorest people.

The Wanganui dentist is serving his second tour of duty in Africa with Mercy Ships. This month-long humanitarian adventure has taken Reid to post-Ebola Benin, where he is treating up to 18 patients living in poverty each day.  On appointment days, the dental team arrives to the on-shore clinic with hundreds in pain lined up and waiting for help that is otherwise simply inaccessible.

Reid finds the long hours and demanding work challenging but extremely rewarding. “I think the biggest factor we encounter is the lack of dental treatment available.  Small problems get bigger and bigger when left untreated.   We see some very extreme cases, so much more advanced than anything I would see at home.  I had a teenager in today who had infection draining from a tooth out of his neck and it had been like that for two years!  We had a couple of patients in yesterday with really advanced oral cancer involving their tongue, neck and throat.  Last week there was a patient who had dead and infected bone in his lower jaw that was so bad that his jaw joint had rotted away!”

Reid discovered some surprises upon his return to post-Ebola Africa.  “It was interesting talking someone on the ship the other day who said the overall mortality rate dropped significantly in West Africa during Ebola – because people were so much more careful about hygiene and transmitting infectious diseases!

“I think it is a great opportunity to be able to assist developing nations with their health care and training and supporting their health workers.  It gives you a different perspective on life and appreciation for all we take for granted.”

Each year the Mercy Ships crew provide more than 20,000 dental services, in addition to thousands of medical and surgical services, at no charge. They work alongside local government providers to improve local health care delivery systems in nations at the lowest end of the UN Haman Development Index.

More information;  visit www.mercyships.org.nz

ABOUT MERCY SHIPS:

Mercy Ships uses hospital ships to deliver free, world-class healthcare services, capacity building and sustainable development to those with little access in the developing world. Founded in 1978 by Don and Deyon Stephens, Mercy Ships has worked in more than 70 countries providing services valued at more than $1 billion, with more than 2.56 million people directly benefiting. The Africa Mercy is crewed by 400 volunteers from up to 40 nations, an average of 1000 each year. Professionals including surgeons, dentists, nurses, healthcare trainers, teachers, cooks, seamen, engineers, and agriculturalists donate their time and skills to the effort. With offices in 16 nations including New Zealand, Mercy Ships seeks to transform individuals and serve nations one at a time.

 

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