Working Together for Better Health
Here on the Africa Mercy we are confronted with medical challenges that few people in developed countries have seen outside of text books. Some, such as the poverty-based disease called Noma, have been eliminated thanks to improved nutrition and living conditions. However, most of the medical concerns we see here also exist among populations in the USA, Japan, Australia, Italy and the like. It's just that the populations of developed countries have access to and seek out medical care more readily than the population of Guinea, thus resulting in early diagnosis. Subsequently, health problems are addressed before they have the opportunity to cause disfigurement, severe pain, and/or lack of mobility (as examples). Timely diagnosis is not generally the case here. When we talk with our patients at a screening event, it is common to hear that we are the first medical team they have consulted about their condition. Or, if they have a diagnosis, they have done nothing about it.
The question then is why?
There are many obstacles that keep people from getting timely, safe surgical care in West Africa. Cost is a significant factor. To pay for surgery is highly burdensome for families, especially for those that reside in villages and are sustained by subsistence farming or for those who earn just a few dollars daily selling water and snacks on the roadside. Many times families have to borrow money from their community to support the healthcare needs of one person. When considering whether to invest in surgical care for a family member, the price of transportation to the nearest hospital is another consideration. Travel alone can be prohibitive.
This field service, our Food for Life program is based three hours from Conakry in a city called Kindia. I'd venture to say that Kindia is one of the most fertile areas in Guinea; the produce stands are overflowing with watermelons, pineapples, hot peppers, avocados, potatoes etc. So many beautiful colors. Food for Life offers individuals from organizations countrywide the chance to participate in a 22-week train-the trainer course covering topics such as crop rotation, animal husbandry, composting, and sustainable water usage. After participants return to their local communities, our Food for Life crew then travel throughout the country to provide follow-up assistance to the local agricultural projects.
It's beautiful to see patients who were once shy and distraught break out into smiles when you pass by. To wave at them and see them wave back. To speak a few words of their language and hear them laugh because obviously you still need to work on your pronunciation. We even have some patients who, upon discharge from the hospital, are so happy that they return to their villages and start recommending neighbors and family members come see us for registration.
When Dr. Gary recently spoke at our community meeting he shared about a mentee surgeon who told him that above all the surgical skills he learned while working on the ship, the most impactful thing he took away was knowing how to treat one's patients with kindness. It's a concept that's so simple yet so powerful when put into action.
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| Sekouba before his surgery Photo credit: Lara Arkinstall, Mercy Ships |
The question then is why?
There are many obstacles that keep people from getting timely, safe surgical care in West Africa. Cost is a significant factor. To pay for surgery is highly burdensome for families, especially for those that reside in villages and are sustained by subsistence farming or for those who earn just a few dollars daily selling water and snacks on the roadside. Many times families have to borrow money from their community to support the healthcare needs of one person. When considering whether to invest in surgical care for a family member, the price of transportation to the nearest hospital is another consideration. Travel alone can be prohibitive.
In the USA (my home), specialized surgical care is relatively easy to access. Every major hospital in a prominent city prides itself on offering care for multiple surgical specialties, and within each speciality, it will employ a few (or numerous) surgeons to provide that care. The reality differs here. Some countries do not have even a single maxillofacial surgeon, for instance. And in countries that do offer care for specialties such as maxillofacial, plastics, orthopedics etc. the surgeons spend most of their time in the capital city at the best-equipped hospitals. When discussing surgery, one must also acknowledge the critical importance of safe anesthesiology. As I mentioned in my first blog, doctors of anesthesiology are also few and far between - just six work here in Guinea currently.
Fear is another factor that keeps people suffering and away from hospitals. Back in 1996, a documentary (1) released about a hospital in Guinea noted that an estimated 60-75% of people who were admitted to the intensive care unit passed away. Has healthcare improved over the past 23 years? Yes. The same hospital highlighted in the documentary is undergoing major renovations now, so it will be better equipped -in terms of space, structure, and diagnostics - to serve its patient population. Certain care is free in Guinea, such as treatment for tuberculosis and HIV/AIDs in addition to medically necessary cesarean sections. From what I have heard, hospitals have a positive reputation for hernia repairs, women's health, and malaria testing and treatment as well. Even with advances, however, there still seems to be a tendency to associate hospitals with death.
Truth be told, there are persistent challenges. Hospitals - by and large - lack sufficient personnel, consistent electricity, well-maintained equipment, and adequate quantities of essential pharmaceuticals and other medical supplies. While these are contributors to poor outcomes, they do not tell the whole story. People's reliance on traditional medicine, low health literacy, cost burdens, distance to healthcare facilities, and uncertainty about the quality of hospital care keep many from seeking help early-on. All too often, hospitals are viewed as a last resort. People go when they are barely clinging to life. At that point, even the best hospitals in the world would struggle to provide healing.
I like the way one surgeon put it in the documentary:
"Generally in Africa, because of poverty, people never brought their illnesses to the hospital. Instead, it's the illnesses that brought them here. It means patients are never seen in time; they always come when it's too late."
Truth be told, there are persistent challenges. Hospitals - by and large - lack sufficient personnel, consistent electricity, well-maintained equipment, and adequate quantities of essential pharmaceuticals and other medical supplies. While these are contributors to poor outcomes, they do not tell the whole story. People's reliance on traditional medicine, low health literacy, cost burdens, distance to healthcare facilities, and uncertainty about the quality of hospital care keep many from seeking help early-on. All too often, hospitals are viewed as a last resort. People go when they are barely clinging to life. At that point, even the best hospitals in the world would struggle to provide healing.
I like the way one surgeon put it in the documentary:
"Generally in Africa, because of poverty, people never brought their illnesses to the hospital. Instead, it's the illnesses that brought them here. It means patients are never seen in time; they always come when it's too late."
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Mercy Ships is well known for the surgical care it provides on its flagship vessel, the Africa Mercy. However, the work of this organization and its crew stretches so much farther. We have an entire Medical Capacity Building (MCB) department that is responsible for training individuals from various backgrounds, so they can do their jobs with excellence, and in the process, change lives forever for the better. The MCB team is constantly on the go, partnering with the Ministry of Health, universities, health clinics, hospitals, and nongovernmental organizations throughout Guinea to offer courses and trainings on biomedical engineering, surgical nursing, sterile processing, the WHO Safe Surgical Checklist, the Ponsetti method to repair club feet, and sustainable agricultural practices (Food for Life Program). On board the Africa Mercy, select surgeons, anesthesiologists, and nurses mentor Guineans working within the same professional fields. Since the ship is only able to visit each country once every few years, our aim is always to strengthen the local health system so that its people can continue to receive quality, safe care long after we leave.
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| Food For Life: Field prepared for pineapples |
This field service, our Food for Life program is based three hours from Conakry in a city called Kindia. I'd venture to say that Kindia is one of the most fertile areas in Guinea; the produce stands are overflowing with watermelons, pineapples, hot peppers, avocados, potatoes etc. So many beautiful colors. Food for Life offers individuals from organizations countrywide the chance to participate in a 22-week train-the trainer course covering topics such as crop rotation, animal husbandry, composting, and sustainable water usage. After participants return to their local communities, our Food for Life crew then travel throughout the country to provide follow-up assistance to the local agricultural projects.
En route to Nzérékore for a patient selection event back in November, I had the opportunity to stop by the course site for an hour with my team. The students were new to the program at the time. When we met them, they were preparing their first compost pile. It's hard to believe graduation will take place at the end of this month!
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| Food for Life: Classroom |
Dr. Gary Parker, our longest serving surgeon, is an excellent teacher. I know this because I have attended some of his medical in-service talks, which always cover complex medical issues in a way that makes the content easy for everyone to understand. During a previous field service in Guinea, Dr. Gary mentored a maxillofacial professor and a plastic surgeon, guiding them on how to perform cleft lip repairs. At the Conakry screening in August 2018, we assessed nearly 6,000 patients. From that group, we only saw six individuals with cleft lips. I don't know how many cleft lip patients came to our Conakry screening in the previous field service, but everyone who has been on ship for a while was shocked by such a low number. Come to find out, in recent years, the team mentored by Dr. Gary performed hundreds of cleft lip surgeries in the capital city. What a testament to how one's willingness to share his/her expertise and time can have a dramatic positive effect - not just on one individual but on an entire city.
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| Mohammed before and after surgery Photo credit: Shawn Thompson, Mercy Ships |
In addition to offering courses and mentoring opportunities, Mercy Ships invests in infrastructure projects that fulfill its needs during the field service, but which are also intended to benefit the communities served by Mercy Ships for the longterm. As an example, this year we are partnering with Gamal University's Dental School to host our dental clinic. Before the ship docked in Conakry, a number of classrooms at the University were renovated and outfitted with new equipment to prepare for the dental team's arrival. From the outset, our dental team has made mentoring of dentists, dental students, and dental assistants an integral part of its practices in Guinea. The team is also training someone to make dentures. When it comes time for the ship to say farewell to Conakry, the clinic will remain as an established, fully functioning place to be used by the dental school for training purposes and to offer care to the local people.
The practical ways Mercy Ships is able to support a country's healthcare system - from infrastructure to mentoring to actual surgical care - are remarkable and impactful no doubt. And yet, I think some of our greatest influence is birthed out of treating our local partners and patients with kindness, respect, and truth. Time and again our local crew speak of how impressed they are with the way our collective community shows earnest care towards the patients - individuals who are often cast aside, called cursed, and are suffering emotionally and physically. We greet them, look them in the eye, and aim to express God's love for them through our interactions. Each morning my team prays for the patients; it is one of my favorite parts of the day. In the words of Katie Davis Majors, an author, mother of many, and founder of an organization in Uganda called Amazima, "It is a great honor to share the life of another, to bear witness in a way that says, 'You matter. This matters. Your story matters.' Because it does." (2)
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| Dental clinic at Gamal University Photo credit: Shawn Thompson |
The practical ways Mercy Ships is able to support a country's healthcare system - from infrastructure to mentoring to actual surgical care - are remarkable and impactful no doubt. And yet, I think some of our greatest influence is birthed out of treating our local partners and patients with kindness, respect, and truth. Time and again our local crew speak of how impressed they are with the way our collective community shows earnest care towards the patients - individuals who are often cast aside, called cursed, and are suffering emotionally and physically. We greet them, look them in the eye, and aim to express God's love for them through our interactions. Each morning my team prays for the patients; it is one of my favorite parts of the day. In the words of Katie Davis Majors, an author, mother of many, and founder of an organization in Uganda called Amazima, "It is a great honor to share the life of another, to bear witness in a way that says, 'You matter. This matters. Your story matters.' Because it does." (2)
It's beautiful to see patients who were once shy and distraught break out into smiles when you pass by. To wave at them and see them wave back. To speak a few words of their language and hear them laugh because obviously you still need to work on your pronunciation. We even have some patients who, upon discharge from the hospital, are so happy that they return to their villages and start recommending neighbors and family members come see us for registration.
When Dr. Gary recently spoke at our community meeting he shared about a mentee surgeon who told him that above all the surgical skills he learned while working on the ship, the most impactful thing he took away was knowing how to treat one's patients with kindness. It's a concept that's so simple yet so powerful when put into action.
 |
| Sekouba all ready to go home! Photo credit: Lara Arkinstall |
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Mercy Ships' engagement with each country typically lasts for five years, yet it's not until year three that the Africa Mercy docks at the port. Those first two years have an intense focus on building relationships with in-country partners, agreeing upon shared goals, and thinking through an immense amount of logistics together. As the calendar turned to 2019, I began to witness some of this in action. Even while the ship is physically in Guinea, there are crew working diligently to finalize plans for Senegal while also looking ahead to the country we will serve two years from now. It takes a considerable amount of time and concerted effort from many dedicated people to prepare for and carry out each field service. But, what a privilege it is to experience the fruit of working together for better health.
When the Africa Mercy leaves Conakry in June, many crew members will be reflecting on the patients - the thousands of lives that changed within the walls of the hospital, eye clinic, and dental clinic over the last 10 months. Our interactions with the patients and their transformations are indeed so special. However, I hope we will also be filled with anticipation as we think ahead to the number of lives that will be transformed in our absence thanks to the transfer of equipment, knowledge, and skills that took place in all corners of Guinea this field service.
When the Africa Mercy leaves Conakry in June, many crew members will be reflecting on the patients - the thousands of lives that changed within the walls of the hospital, eye clinic, and dental clinic over the last 10 months. Our interactions with the patients and their transformations are indeed so special. However, I hope we will also be filled with anticipation as we think ahead to the number of lives that will be transformed in our absence thanks to the transfer of equipment, knowledge, and skills that took place in all corners of Guinea this field service.
(1) Donka: X-ray of an African Hospital (1996)
(2) Daring to Hope: Finding God's Goodness in the Broken and Beautiful by Katie Davis Majors (2017)
(2) Daring to Hope: Finding God's Goodness in the Broken and Beautiful by Katie Davis Majors (2017)
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