Last week our screening team joined Mission Aviation Fellowship on a flight to Bekodoka, a village Mercy Ships learned about earlier this year. It takes at least 7 days to reach this remote village.
Bekodoka is so isolated people that live there, often haven’t seen anything else. No direct access to healthcare makes it incredibly difficult to get help.
Small medical issues become life threatening situations – only because of the lack of basic healthcare. During our recent visit, Mercy Ships and MAF were supposed to pick up a young girl who was suffering from a large facial tumour.
The flight came too late as the young woman passed away. The tumour pushed against her airway and she died because she couldn’t breathe anymore.
The reality is hard. We see how we can help hundreds, thousands of people every year. As difficult as it was to learn about this, it fires us up to do even more, to make sure healthcare is accessible for everyone.
Although that young woman did not make the flight, 3 other patients came back with us that day that will have free surgeries onboard the Africa Mercy!
We are incredibly grateful for MAF flying the extra mile with us to reach those in need of medical care.
Cardo looked through the lens of the camera. He could see some of his new friends making faces and acting silly. He flashed a smile at the videographer who returned the eight-year-old’s excitement with a big grin of his own. It’s not every day that you witness someone discovering a whole new world. Cardo’s world, which had been limited by a hernia since birth, was about to become a whole lot bigger and brighter.
In a field service, Mercy Ships provides surgeries of various types, including general surgeries. During the Mercy Ships field service in Madagascar, volunteer surgeons performed 335 general surgeries in a 217-day period. Hernia surgeries accounted for 195 of the general surgeries – mostly on children.
“Most kids come in, and they are terrified, and we do what we can to make them feel safe,” shares Naomi Reid, a nurse from Australia, who serves as a screening assistant with Mercy Ships. Most of the children have never seen a doctor.
And those that have previously seen a doctor associate doctors with severe pain and even death. “They see pretty quickly that we are not here to hurt them, but it’s still a scary thing for them. Cardo, however, was the exception,” Naomi added.
Naomi recalled the comical scene of evaluating the eight-year-old boy who proudly marched into the screening tent and removed his pants for the doctor to see his hernia, which had formed in his groin area. Observers couldn’t help but chuckle at the ease with which Cardo removed his pants.
“He just dropped his drawers as if to say, ‘Yes this is me,’” said Naomi with a laugh. The scene, although amusing, did not underestimate the seriousness of Cardo’s visit.
Cardo’s mother discovered early on that there was something wrong with her baby boy’s groin. She took him to local doctors who diagnosed him with a hernia – a protrusion of an organ or tissue through the surrounding wall of his groin. Doctors delivered good and bad news – they could perform a surgery that would correct the hernia, but it would be very expensive. As a single mother with three children, Cardo’s mother could not afford such a surgery. She prayed for a solution.
One day she heard the answer to her prayers. A radio announcement announced that Mercy Ships offered free surgeries, and they would be selecting patients at the nearby town of Toliara, located in the southwest region of Madagascar. She sent Cardo to Toliara with his Uncle Ernest, and from there they made the two-day journey by car to Toamasina where the Africa Mercy was docked.
Just 24 hours after his operation, Cardo was ready to get behind a camera again! Free of his hernia, Cardo will have a chance to make even his newest dream of becoming a filmmaker true. Even acclaimed movie director Steven Spielberg could not have scripted a more perfect ending.
Story by Tanya Sierra
Fenosoa and his grandfather have a really special connection. They share a hut in their village, “because he loves me,” explains Papa Denis with a two-tooth grin.
It was Papa Denis who heard on the radio about Mercy Ships coming to Madagascar and providing free surgeries for people with specific conditions.
They were elated. Five years earlier, Fenosoa had been born with a cyst on the side of his abdomen that had grown along with the boy. It looked like an army water canteen tucked beneath his skin, and his friends teased him about it.
So, 86 year-old Papa Denis and his beloved grandson began their intrepid expedition. Together with a friend to carry their supplies, they walked for five long days through bushlands to reach the public transport.
Over three more days, minis buses brought them progressively closer to their destination; the Mercy Ship in the port of Toamasina and the surgery that Fenosoa desperately needed!
Fenosoa and his GrandPa chatted constantly as he recovered from surgery in the Mercy Ships ward. He was so excited his one-pound cyst was removed, and laughingly declared, “I don’t know what happened. I was sleeping, and when I woke up, it was gone! I am very happy.” No longer would the growth make him fall over, or be the subject of ridicule from his friends.
Fenosoa can’t wait to get back to his village. Back to endless soccer matches and marbles; rowdy games played by little boys around the world regardless of the language they speak.
The Secret World of the Sterile Processing Department – onboard the Africa Mercy
Surgeries are the major focus of work on the Africa Mercy. How do all those instruments get cleaned and sterilized? The Sterile Processing Department on Deck 3 is below the water level, on the same floor as the OR. It is rather a world unto itself-lying behind access restricted doors.
Here a team of 4 crew members and 2 day workers toil in extreme temperatures from 7:00 am- to as late as 3:00 am. All instruments for each surgery, ward, crew clinic and out-patient area are processed through this department.
The work is very labour intensive, with each instrument needing to be hand scrubbed before they are placed in a commercial washer/dryer. They are then inspected, hand packed into sets on trays, wrapped, sterilized, cooled and taken back to a clean storage area.
The work is rather hazardous – handling sharp instruments with exposure to both blood and body fluids. All staff must wear PPE (Personal Protection Equipment) which includes gowns, double gloves, full waterproof gowns, full face masks and shoe covers. This makes the job even more uncomfortable and awkward in the hot and humid temperatures.
But the most convincing reason is that this is the only place on the ship where literally your hands touch each and every life that is transformed. Awesome.
– Jane, Donor Relations, Mercy Ships Canada (and previous Sterile Processor and long term volunteer onboard the Africa Mercy!)
EARLIER this year in Madagascar, a man in his 60s named Sambany made international news after volunteer surgeons from Mercy Ships removed a 16-pound tumor from his face. For decades, he had sought treatment at 10 hospitals, most of which lacked surgeons. He was ostracized, then physically unable to work. His family had to sell a rice field just to pay for the cost of getting to the hospital (the surgery itself was provided free).
Earlier this week, the United Nations adopted 17 proposed sustainable development goals, which reflect the resolve of world leaders to “end poverty and hunger everywhere; to combat inequalities within and among countries; to build peaceful, just and inclusive societies.”
Although admirable, these goals cannot be achieved without explicitly addressing one of the most crucial needs facing the world: a lack of access to surgery. The aim of universal access to “health care and social protection, where physical, mental and social well-being are assured,” will come to nothing without it.
Most of the world lacks access to safe, affordable and timely surgical care.
Every year over 80 million people worldwide face financial catastrophe if they get surgery. And while the individual cost of getting surgery is great, the societal cost of inaction is staggering. If nothing is done to increase surgical access, developing nations are projected to lose $12.3 trillion from their gross domestic products between now and 2030.
Currently, infectious disease interventions are the main focus of global health policies, because many countries lack the personnel and infrastructure to carry out surgical interventions successfully.
Despite the fact that nearly one-third of human disease is amenable to surgery, it remains overlooked in much of the world.
This is shortsighted. After all, the treatment of solid tumors in the United States began with surgeons: William Stewart Halsted described the surgical removal of breast cancer in 1894, well ahead of chemotherapy. Surgery and early detection alone drove substantial drops in breast cancer mortality. Today over 60 percent of cancer diagnoses benefit from surgical intervention.
Surgery is more than just facial tumors, breast cancer and trauma; it is a crosscutting intervention, involved in every disease category from infections to blindness, from congenital abnormalities to maternal conditions, from the neurological to the cardiac to the neoplastic. To put this in perspective, H.I.V., tuberculosis and malaria — which have captured the global conversation — currently make up less than one-tenth of the global disease burden, combined.
Why, then, has surgery been ignored? In part, because expanding surgery seems daunting and expensive. Why not just focus global energy on vaccines, for example, which can be mass-produced and delivered to the population, rather than scaling up an entire health infrastructure? After all, providing surgery requires reliable electricity, water, suction, sterilization, oxygen — as well as surgeons, anesthesiologists, nurses and biomedical technicians.
But this is exactly what makes improving surgery ideal. Improve a surgical system, and you improve the very things that are necessary for the delivery of health care in general. Doing so is less costly than it might initially seem. The cost of scaling up a surgical system in resource-poor countries — about $300 billion over 18 years — represents only about 5 percent of the total combined expenses that governments in low- and lower-middle-income countries spend on health annually, and pales in comparison with the $12.3 trillion cost of inaction. And spending that money now will not only lower the current surgical disease burden and allow patients to return to economic productivity, but it will also make the health system itself more resilient when shocks like Ebola hit.
Moreover, reliable surgical infrastructure strengthens entire health systems. It is not enough to prevent maternal deaths during childbirth if a health care system cannot care for the children after birth. It is not enough to treat tuberculosis successfully if the patient then dies from a perforated appendix. Surgical scale-up is not and has never been envisioned to exclude other global health priorities — surgery is necessary to meet all global health priorities.
It is this inherent synergy that makes surgical delivery a cost-effective intervention. Researchers from Harvard and Stanford Universities, including one of us, recently compared the cost-effectiveness of surgical care with that of multiple accepted global health interventions.
They found that general surgeries, ophthalmic surgeries and cleft palate repairs, among others, had a similar cost effectiveness to some vaccinations, and that cesarean sections and orthopedic surgeries were potentially more cost effective than medical treatments for heart disease and H.I.V.
For Sambany, surgery was a personal issue. For developing nations, it is an economic issue. For the world, it is a moral issue, a question of equity. Surgery has been called the “neglected stepchild of global public health.” To achieve the recently approved global development goals, world leaders must explicitly develop systems to bring access to safe, affordable and timely surgery to those who need it.