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Crowds wait for the chance for free surgery
Crowds wait for the chance for free surgery

Lack of access to safe surgery results in more deaths worldwide every year than HIV, tuberculosis and malaria combined, according to the World Health Organisation (WHO).

There is growing international acknowledgement of what theatre staffs have long known and advised: accidental trauma, birth complications and the lack of surgical intervention for amenable disease conditions causes millions of people annually life-long disability or death.

Empowered by the rising profile given to the accessibility of surgery in developing nations by the findings of The Lancet Commission on Global Surgery a movement has begun; a new determination to make access to safe and affordable surgery for the poor a reality.

For nearly 40 years Mercy Ships, the hospital-ship charity, has quietly made it a priority to provide safe surgery for people who otherwise would have no options. Mercy Ships joined the newly formed Global Alliance for Surgical, Obstetric, Trauma and Care (G4 Alliance) in 2015. The Lancet Commission’s report was published later that year with a vision to ‘embed surgery within the global health agenda, catalysing political change, and defining scalable solutions for provision of quality surgical and anaesthesia care for all.’ Together these bodies are stimulating a growing recognition that safe surgery must be an integral part of the global health agenda.

Esther Meyer enjoying down time on deck with some of her patients
Esther Meyer enjoying down time on deck with some of her patients

During 2014–2016 the Mercy Ship Africa Mercy completed two ten-month tours of duty in the island of Madagascar, off Africa’s eastern coast where 95% of Madagascar’s 23 million people live on less than $1.25 per day to cover all their needs: food, shelter, clothing, education and healthcare. Since much of the population lives in remote villages, it was common for patients on the hospital ship to explain how they had walked for days – sometimes carrying a child – to reach any public transport. From this point, basic healthcare may be accessible, but at a crippling cost. Before any treatment is undertaken, the patient must pay for – and sometimes even source – sutures, IV bags and fluid, dressings, bandages and pharmaceuticals, everything that is needed for treatment. So when free reconstructive or life-saving surgery was offered by Mercy Ships, patients and their families often broke down with tears of relief. Few had any other options, or even hope, for healing.

While in Madagascar, Mercy Ships launched a mobile education team. The ‘Checklist’ team of three to five doctors and nurses travelled a gruelling 16,829 kilometres to every regional hospital, even in the most inaccessible areas. They coached local healthcare professionals in the understanding and use of the WHO Surgical Safety Checklist. This simple tool helps any surgical team to improve safety in surgery. It has been proven that using the checklist has decreased operating room mortality by nearly 50% and significantly decreases surgical complications and infections.

In New Zealand and many parts of the world, this checklist is now mandatory. In Madagascar it was not utilised effectively. Mercy Ships came alongside every region in the country and assisted them in creating their personalised checklist and provided the participating hospitals with pulse oximeters.
Safer surgery is being performed throughout Madagascar as indicated by a follow-up visit after three months which showed a Checklist usage rate of 80%. Further assessment will take place in 2017. The Checklist team collected national healthcare data never previously compiled, and worked with other organisations to support the government in developing a national surgical plan.

In August the Mercy Ship sailed to Cotonou, Benin where the crew have 10 months to engage in medical capacity-building and provide healthcare for thousands more Africans in desperate need of both hope and healing.

Esther Meyer
Each year dozens of New Zealanders – including theatre nurses, anaesthesia staff, surgeons and other healthcare professionals – volunteer with Mercy Ships. The not-for-profit is Africa-focused, with a mission to provide free surgery for those in greatest need, and to train medical professionals to continue their work long after the ship departs.

Esther Meyer, theatre nurse from Drury volunteered for five months in the on board theatres during 2014, in the Republic of Congo. She found it to be impacting both on a professional and a personal level. Esther explains, “As the Mercy Ship is a floating hospital it is able to move to different locations, while still providing an excellent standard of care. It provides a place where local health professionals can come on board to learn valuable skills, without having to leave their own country.

“The camaraderie between the volunteers is unique. No one gets paid and there is no hierarchy in the operating room. We worked hard as a team with all the same goal in mind. The operating room is a fast paced and fast turnaround of staff. In New Zealand we have a wide range of ethnicities, so it wasn’t hard to feel at home. There is a mixture of British and American terminology inside the operating room, but plenty of understanding and patience. Laughter helps to break down barriers, and friends are made quickly. To be able to serve alongside such knowledgeable people, and to have the opportunity to learn from them, was very exciting.

Posted with permission by The Dissector December 2017

Video link : The Mercy Ships response to Global Surgical Need (3 min)

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The Press brings in the New Year by interviewing Jess Doney on her return from the Mercy Ships wards. Read Nursing on a ship in Africa

Jess Doney (NZL) Ward Nurse, Adult ICU

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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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Hannah fitting Jimmy's prosthesisHannah Rutherford recently volunteered with the world’s largest civilian hospital ship, the Africa Mercy. The Mercy Ship was docked in Madagascar, and Hannah describes how she was impacted professionally and personally as she worked alongside the international teams providing healthcare services to people in extreme poverty.

 

After studying at Otago University and graduating in 2010, Hannah worked for Counties Manukau District Health Board for two and a half years before moving to Sydney in 2013. In Australia I work at the Sydney Adventist Hospital as a cardiorespiratory physiotherapist.

 

“I first heard about Mercy Ships from a colleague whilst working as a rotational physiotherapist at Middlemore Hospital for Counties Manukau. Her enthusiasm was contagious. My desire to travel and learn about another culture meant this organisation caught my interest immediately. What I didn’t realise at this early stage was that the Mercy Ship would offer me so much more than an opportunity to work abroad as a physiotherapist,” says Hannah.

 

Mercy Ships is an international NGO that has operated a fleet of hospital ships in developing countries since 1978. They enter port cities at the invitation of a country’s government. They then work in that country alongside government, international and local NGOs and local church partners for 10 months of field service Their aim is to support a country’s health delivery by providing training and completing medical-capacity building projects. This leaves the country with a much stronger and sustainable healthcare system at the completion of the field service. Throughout each field service they also address immediate healthcare needs by providing thousands of free surgical services that are not available within the host nation.

 

Burns paitents need pysio to regain movement after surgeryHannah had the privilege of living and working on the Mercy Ship from January to May of 2016. The Africa Mercy houses a crew of 450 volunteers from around the world. The lower level of the ship is largely taken up by the hospital. The ship has five operating theatres and eighty inpatient beds over five wards. It is supported by dental, pathology, radiology and, of course, rehabilitation services.

 

Hannah worked as a member of the rehabilitation team alongside four other physiotherapists and two occupational therapists. The main role of the rehabilitation team is to provide therapy services to patients receiving orthopaedic or plastic reconstructive surgery. The team also treats patients from any specialty if a need arises, and even members of the crew for urgent musculoskeletal conditions. Whilst in Madagascar, Mercy Ships provided 99 orthopaedic and 102 plastic surgeries, in addition to hundreds of other surgeries, free of charge.

 

“While I was on the ship, the bulk of our caseload consisted of patients with congenital deformities, severe wound infections, or burn scar contractures that required plastic surgery.”

 

The rehabilitation team worked on the wards and in a military-style tent on the dockside. The tent at times housed six therapists and five interpreters, all working with patients and their families at the same time. This, along with the language and cultural barriers, limited resources and a restricted time frame, added to the challenges we faced with the clinical work they were doing.  “It was the craziest, but equally the most supportive, work environment I have ever been in. Many of the conditions we treated were made more complicated by the delays in the patients accessing health services,” says Hannah.

 

As a team they had many brainstorming sessions where they shared their expertise and supported each other in problem-solving the unique issues they were presented with. “Somehow we always managed to find a way to provide the best care for these patients. I believe we covered almost every area of physiotherapy while I was working there. One moment we would be prescribing bubble PEP and other respiratory treatments for a five-year-old, and then treating a man who had ataxia following a severe head injury. There was lots of shoulder rehabilitation following axilla releases, hand therapy and treatment of musculoskeletal injuries. In addition, we were making all of our splints and orthotics. We had limited resources for this and often had to get creative with our designs.”

 

Hannah volunteered as a physio in MadagascarHannah’s Mercy Ships experience was a huge learning curve and an opportunity for growth both professionally and personally. “It was the most rewarding work I have ever been part of. As physiotherapists, our goal is to restore function. We were part of a team that provided a service that completely changed these patients’ lives by restoring a function they thought they had lost forever. With these patients we had the opportunity to help them regain movement in a limb where previously there had been none. It was the coolest gift you could ever give someone.”

 

“I met Jimmy on my second day in Madagascar. Mercy Ships had offered him a below-knee amputation, and he presented limping, with his leg wrapped in a filthy blanket and covered in flies. Jimmy told us his leg had been badly burnt when he was 11 years old, and the wound had never healed. Now aged 28, his leg was so badly infected the bones were exposed and he could not weight-bear on that leg. Mercy Ships offered him a below-knee amputation, and following this Jimmy’s rehab was initially straight forward, involving stump bandaging and strengthening work. Our first real challenge came when we decided to make a temporary prosthesis so that he could start partial weight-bearing. This involved some trial and error with the resources we had on hand, but we eventually had an effective prosthesis made out of casting material and the end of a crutch. Jimmy’s progress was nearly derailed by the growth of a bone spur at the end of his tibia. The original surgeon’s volunteer service had concluded by then, so we asked around the group of surgeons on board at the time if anyone would be comfortable operating on him. One plastic surgeon, whose specialty was facial surgery, offered to help.

 

Because Jimmy had to return to theatre for the spur removal, he was not ready for a prosthesis until our last few weeks in Madagascar.  We paid a local prosthetist to make him a permanent prosthesis; it cost about $80 and took one week to make. Jimmy would never have found the money to pay for it himself. He quickly and competently took ‘on board’ everything we taught him. He was walking unaided his prosthesis by the time Mercy Ships bade farewell to Madagascar’s shores.”

Posted with permission. Physio Matters, December 2016. Publisher Physiotherapy New Zealand

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2.5 min VIDEO: Unable to walk far enough to get to school, this bright little girl and her family were heartbroken over what her future would be – until they heard about another girl whose legs were straightened for free by Mercy Ships. Fifalina’s tenacity and zest for life will brighten up your day in just 2.5 minutes!

Watch Fifalina's miracle happen

 

 

 

 

 

 

 

 

 

 

Watch Fifalina’s transformation

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At 7 mths Haingo was newborn size
At 7 mths Haingo was newborn size
Haingo was born in a tropical downpour. Even in the hut’s dim light it was clear Hiango’s tiny mouth was slashed by a bi-lateral cleft lip. Her mother Viviaby’s joy turned to sadness, and her father immediately rejected the newborn saying, “In our family we don’t have babies like this!”

No one in their Madagascan village had heard of this disfigurement. “Is it because of something that I did?” Viviaby wondered. “But I am a Christian, we have nothing taboo (cursed). If God gave her to me like she is, He knows how to take care of her.” But the visible deformity was the least of Haingo’s problems.

The situation became dire as days passed and Haingo was unable to breastfeed because of her cleft palate. The hole in the roof of her mouth prevented Haingo from sucking. She cried incessantly. Her father said, ‘It’s not going to survive so you’d better kill it!” Her mother declared, “Let her live!”
Viviaby kept Haingo alive with diluted canned milk – each can costing a day’s wages. Still Haingo failed to thrive. “I did not have money to buy something good for her, recalls Viviaby. “She was getting more and more skinny. I was afraid, I was always praying.” At seven months old Haingo weighed only 2.2kg.

On every side Viviaby encountered superstition and cruel comments – until one day women who recently received free surgeries on the Mercy Ship walked by their secluded village. They heard about Haingo. “There is free treatment. You should bring your baby there!” they shared.
So for two days petite courageous Vivaby carried her baby through rugged countryside to find transport to the Mercy Ships patient screening in her region.

The urgency of Haingo’s situation was accessed by screening coordinator Mirjam. “Haingo was seven months old, looked like she was only two months. I was surprised she was still alive. I realised we couldn’t do surgery straight away. She would have to be in our Infant Feeding Program to gain weight.” Haingo and her valiant mother accompanied the team returning to the Africa Mercy on a Mission Aviation Fellowship flight.

With loads of TLC Haingo gained enough weight to have surgery
With loads of TLC Haingo gained enough weight for surgery
Mother and daughter were rushed onboard the hospital ship, and paediatric nurses began around-the-clock emergency nutrition. Shelby was charge nurse when Haingo was admitted. “She was so small! If you didn’t know her age you would think she was newborn.”
Viviaby slept well for the first time since Haingo’s birth because “They were feeding her with an (oral feeding) syringe because she couldn’t suck a bottle,” she explains.

Haingo began to gain weight and become responsive. Viviaby talked with other mothers of cleft lip babies in the ward. She was comforted, and she no longer felt alone. After 10 days Haingo was stabilised and discharged to the Mercy Ships HOPE (Hospital Out Patients Extension) Centre. Haingo’s weight was tracked, her development and care discussed in the Infant Feeding Program (IFP). “I love seeing the transformation as the infants gain weight, get stronger and reach developmental milestones,” shares Mercy Ships dietitian, Jillian Davis (USA), ‘A most impacting aspect is the parents gaining hope.”
“Before, Haingo was crying a lot because she did not eat enough. But now she is happy! She has enough food!” exclaimed Viviaby.

As Haingo grew, she began to do all the heart-warming things that babies her age are purposed to. She tracks movement with eyes that were previously glazed, and waves ‘Veloma’ (goodbye) with the chubby arms that had been so frail. After five months Haingo reached 3.5 kg, and the vital ‘average weight for height’ benchmark. At last she was strong enough to undergo operations to repair her cleft lip and part of her palate.

As Haingo came out of the first surgeries, Viviaby gathered her baby in her arms. “She’s beautiful!” was all the overwhelmed mother could say.
When Viviaby and Haingo returned to their village, Haingo’s four-year-old brother was distraught. “You exchanged my sister!” he accused, “It’s not my sister!” The villagers too were amazed by the extraordinary change in Haingo’s appearance. Viviaby explained the remaining surgery would fix all of the baby’s problems.

At 13 months old Haingo received her finial free operation. Only now, with her palate closed, can she eat and drink normally, with the ability to speak clearly.

Viviaby reflects, “Nobody believed someone could help Haingo. Without Mercy Ships, Haingo would have died. But my baby is healed!”

Haingo’s life was transformed by mercy.

Haingo was transformed by mercy
Haingo was transformed by mercy

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Fenosoa and Papa Denis have a very special relationship Fenosoa and Papa Denis have a very special relationship. Although Fenosoa’s family live in the same Madagascan village, he shares a hut with his grandfather. Why? “Because he loves me,” explains his grandfather, Papa Denis.

Fenosoa was born with a cyst on his side. For five years it grew along with the little boy, sometimes making him lose his balance.
Papa Denis heard a radio broadcast about Mercy Ships providing specific free surgeries in Madagascar. The family was elated. So the tenacious 86-year-old and his pint-sized grandson walked for five days to reach the nearest public transport. Over three more days, mini-buses brought them progressively closer to the Mercy Ship … and the surgery Fenosoa desperately needed.

The screening team said Mercy Ships could help Fenosoa – but the 2014-15 field service surgery schedule was full. The boy and his grandfather made the huge journey home with his precious appointment card and confidently returned for surgery during the folowing Madagascar field service. They had now walked for 15 days to get the help Fenosoa needed.

Grandfather and grandson chattered endlessly, and their deep love for each other was evident. The boy’s 750- gram thin-walled cyst was removed by Mercy Ships’ volunteer surgeons. Fenosoa was mystified. “I don’t know what happened. I was sleeping, and when I woke up, it was gone!”

Fenosoa is the youngest person from his isolated village to journey to the coast. It was going to be tough to explain a hospital ship to his playmates. He thought hard as he sat on his bed in the ward. “The ship is so big, it looks like a village!” he said.

With a two-tooth grin, Papa Denis said they would take it easy after the young boy’s recovery from surgery – they would take six days instead of five to walk home … and set a slower pace!

Relieved of his life-long burden, Fenosoa could not wait to get back to his village friends. Back to endless soccer matches and marbles – all of the rowdy games played by little boys around the world, regardless of the language they speak.

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