So Much in so Little Time

It's difficult to know where to begin. So much has happened in the last two weeks. In some ways, I feel like my time here in Guinea has already stretched out over months. The amount of work done is extensive and yet the field service is really only getting started. I debated about just sharing a story or two here, but I figure this time around it's probably helpful - and is perhaps interesting - to narrate some details.

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The sun was beginning to rise in the morning sky on August 20th as we drove to the People's Palace, the location for the screening event in Conakry. From a distance, we could see a sizable crowd waiting alongside the street, no doubt comprised of people eager to be seen by our medical team. Nearing the vehicle entrance, we had to stop our Land Rovers and vans as people quickly passed in front of them on their way to join the others. Once inside, we parked, exited the vehicles with all our supplies and set up our respective stations outside in front of the Palace. By around 7 AM we were all ready - the screening administration table, the screening nurses, patient escorts, the communications team, and security.

Despite our anticipation, patience had to take precedence. The crowd outside the main gate was not well organized. Our security team, the local police, and Gendarmes attempted to institute a better sense of order to ensure safety upon entering, but desperation and uncertainty seemed to push aside reason and understanding among the crowd. And so, we waited. After two hours, those involved with security operations decided to open another gate near the end of the "line" where people seemed relatively calm. The part of me that holds tight to a sense of fairness was taken aback by this decision, and yet, it was the sound option. Once inside, people's moods seemed to change. They appeared more at ease now that their goal of seeing the medical team was within reach. Over the course of the day, the nurses assessed around 6,000 people.

Waiting outside at the People's Palace (Palais du Peuple)

Training alongside the screening nurses during our sail from the Canary Islands to Guinea made me want to be part of the actual screening efforts at the Palace. However, my public health background didn't afford me that opportunity. My role during the day was to give Evaluation Days appointments and wristbands to those who received a "Yes" from the nurses. More on Evaluation Days soon. 

Even though each potential patient was fatigued after many hours of standing and waiting, they were always cordial to me and thankful. No one complained. I got to practice a bit of French and share smiles with everyone while my interpreter - Madeleine - did most of the talking. She speaks eight languages well - French, English, Susu, Malinke, Mano, Kissi, Kpelle and a language from Cote d'Ivoire too. All day long she switched from one to the other; I was so impressed.  

One-on-one time with potential patients

Once the screening process commenced, the time went by quickly. I looked up from my work around 6 PM and saw only a few remaining people in line. Just like that, this important day that required many months of planning was coming to a close. I was invigorated and grateful for the experience. I didn't really want it to end.

Back at the dock, we were greeted by cheering from friends on Deck 7.  The dining room stayed open late in order to provide us with a proper meal. This felt like a big deal because the dining staff already work ~11 hours on a normal day. We also learned that our fellow crew members prayed for us throughout the day as the Operations Director relayed updates from the Palace over the ship's intercom system. 

While some of my teammates went to bed soon after getting back to the ship, I stayed awake for hours feeling full of energy and happiness. The next day, however, was rough. My adrenaline was gone, and I felt so tired. No time to lose though; Evaluation Days were about to begin. 

Starting August 22nd, we hosted five Evaluation Days - also at the People's Palace. Evaluation Days are an opportunity for the screening team to spend more time with potential patients in order to better assess whether they are strong surgical candidates. Individuals passed through a series of stations during their appointment - demographic data collection, vital signs, nurse assessments, scheduling, badge making, and pharmacy (for vitamins). We also had a nutrition team onsite to provide support to potential patients who were noted to be malnourished - such as babies with cleft palates who were struggling to breastfeed.

While the nurses did have to say "No" to some individuals during the Evaluation Days, the majority of people were given future appointments. My responsibility in all this was to take pictures and make badges for each potential patient and caregiver (as required). The badges grant potential patients access the dock - and eventually the ship - if surgery is scheduled.

We concluded our Evaluation Days on Tuesday the 28th, packed up our supplies, and headed back to the dock to quickly stock and organize the screening tent for the arrival of potential patients with appointments the next morning.

Shortly after 6 AM on Wednesday, I headed out to our patient assembly point in the city with two of the local crew. There, we greeted potential patients, checked them in, and put them on buses headed to the dock. All the individuals that day were seeking care for issues related to the jaw and face, such as cleft lips, cleft palates, and tumors.

Inside the screening tent on the dock, additional health-related questions were asked, vital signs were taken, blood was drawn, CT scans were ordered (as needed), and each potential patient met Dr. Gary Parker – a surgeon who has served with Mercy Ships for more than 30 years. Ultimately, the surgeons - with input from the screening team - have the final say in whether an individual will receive surgery. 

On this day, soon after the patients arrived, the heavens poured down rain harder than any day since our arrival in Guinea. Back at the assembly point, about two inches of rain pooled in parts of the waiting area and the streets started to flood. On the dock, the temporary canopy assembled to cover patients from sun and rain started to leak in many places, as did the front part of the screening tent. The team scrambled to move computers away from the water and potential patients into the back of the tent to avoid getting soaked. It was a hectic and long day. 

The screening tent, now covered in a tarp to keep rain from leaking inside

After two more dockside days, one for individuals needing the care of a plastic surgeon and another focused on general surgeries, such as hernia repairs, the week finally came to a close.

Aside from four upcountry screening events in October and November, the screening team members will now work at the assembly point, on the dock, and in the screening office on the ship. As we settle into our new routines and responsibilities, inside the hospital, the nurses, surgeons, and anesthetists, biomedical technicians, laboratory technicians and others are gearing up to accept the first surgical patients.

Operations start tomorrow morning!