If you’ve had surgery in the last decade you may recall being asked several times on the day of surgery questions like what is your name, what are you here for today, and do you have any allergies.
When I was asked these questions a few years ago before undergoing shoulder surgery, I wondered to myself “Shouldn’t you know this? You’re operating on me!” – but now I understand; they do know, they are just following the Checklist.
The World Health Organizaiton (WHO) Safe Surgery Saves Lives Surgical Safety Checklist (aka. the Checklist) is a simple tool that helps the surgical team to improve safety in surgery and has been proven to decrease operating room mortality by nearly 50%, as well as significantly decrease surgical complications and infections.
It doesn’t require fancy equipment or expensive drugs; meaning it can have as large of an impact in Dallas or Minneapolis as it does in Beijing or Nairobi or Toamasina. You can read more about the checklist Here.
The only piece of the Checklist that actually costs anything is the use of a pulse oximeter; so for this we have teamed up with Lifebox, an organization dedicated to ensuring every operating room in the world has this vital tool, to offer pulse oximeters where needed.
You might be thinking, “Well that sounds great and simple, just teach people how to use it!” – if only it was that easy.
The Mercy Ships Medical Capacity Building program has been working for years to try and figure out what it takes to successfully implement the Checklist in the local hospitals where we are serving.
Behavior change is hard; just because we know we should floss our teeth every day doesn’t mean we actually do it. Just because we know we should use a checklist before surgery doesn’t mean we actually do it.
We first experimented with some teaching in Guinea; expanded it in Congo, and this last field service in Madagascar we worked alongside the OR teams in Toamasina and Mahajanga to develop a practical, modified Checklist, tailored to the needs and requirements of the hospital.
This year we’ve expanded – from two cities to twenty! By empowering and inviting the OR teams themselves to develop their own checklist, we hope they will continue to use it long after Mercy Ships departs!
Through this simple checklist, we could see transformation of surgical care in this country and beyond.
Stay tuned for the Checklist Project part 2 – Madagascar!
– Krissy Close, Medical Capacity Building Manager AFM
In the meantime, here is an overview of the steps:
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!)