Sunday, September 21, 2014

Africa Mercy - Madagascar, Here We Come! One Nurse's Journey

Finally up to date on Marilyn's emails. The Africa Mercy is Madagascar bound and likely in rough seas. Pray for the crew's safety and that Marilyn can handle the sea sickness! Sharon

(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast).

15 September 2014--Monday
"Madagascar, Here We Come!"

We are at sea--literally, instead of figuratively, which is a
pleasant change. We left Las Palmas Saturday evening, headed for Cape Town. The sail should take about 18 days, more or less,
depending on sea conditions. So far, we've had excellent sailing.
We got out of the Canaries ahead of a storm, and we have both sea current and wind pushing us along faster than we could otherwise go. They say the calm waters should continue for at least another day...but they predict rough seas further south.

I, for one, am easily troubled with seasickness. I'm faithfully
taking medication, yet I was borderline queasy yesterday morning, on these almost glassy seas. Oh, boy. What have I gotten into?

I'm going around the notorious cape in a boat? Me? This ship used to be a railroad ferry, traveling in protected waters. It has a shallow keel, so it bobs and rolls more than a ship designed for
open seas... Well, it will be "interesting."

We still do not have a dry dock birth in Cape Town, and we need
one. It seems that every "motel" is booked already--no place for
us to stay. We are praying that something will open up by the time we get there. And, I assume, the leadership is working on yet another "Plan B" in case there are no cancellations. So, any and all plans for what we do in Cape Town are still very much in the "fluid" stage.

On the other hand, plans for the field service are beginning to
solidify. We're going to Madagascar. Madagascar is a big country: 250,000 square miles, larger than California, almost as large as Texas. It once was reasonably developed, but not any more. I hear that even the main "highways" are often dirt roads. The people are extremely poor; health care is as scanty as in West Africa. There are 18 tribes, with racial origins as diverse as Polynesian, Indonesian, Arabian, Moor, and sub-Saharan African, but Madagascar is no "melting pot." Tribal rivalries and prejudices make governing very difficult. As elsewhere in Africa, corruption is rampant, making economic development difficult. In other words, its "our kind of place," a place that needs a lot of assistance.

Toamasina, where we'll be, is a small port city on the eastern side of the island. Open to the Indian Ocean, it experiences cyclones with some regularity. The rainy season starts about the time we get there, and lasts until about the time we leave. Sigh. That always makes things complicated--dirt roads, travel difficulties, people not coming for appointments. The city itself is quite small, which means that most of our patients will probably be found in the surrounding rural areas. Travel is likely to be one of the major hurdles we face, both for ourselves and for our patients.

We have an advance team in country already, working to gather
information and to set as many things in place as possible before
we arrive. I hear that they are doing very well--lots of meetings
with all levels of government officials, and the meetings have been quite productive. Information that the eye team needs is on the list of things to be done when time allows, but we don't have much feedback yet.

Meanwhile, work in the dining room continues. We've switched to an every other day schedule during the sail, which I think I will like even better than the two on, two off, and work every other weekend schedule that is the normal one. Yesterday was a work day for me, and apart from some seasickness in the morning, it went smoothly.

I tend to sleep for an hour or two between meals; it is enough to restore my energy for working the next meal. Today, I'll probably spend the afternoon on the deck, just watching the ocean. It is such an odd sensation not to be able to see land anywhere. We are a very small cork, bobbing alone in a very large bathtub. Of course, in this day and age, we are still connected to the world electronically. What must it have been like to be a small ship with no engine, no maps to guide, no information about "country next," no connection to the known world, and no rescue possible? Now that was adventurous!

Marilyn Neville

[Click here to learn more about the nurses and doctors on board the Africa Mercy.]

Africa Mercy - We Have a Plan...Fluidly Speaking: One Nurse's Journey

This from Marilyn on the Africa Mercy, the first week in September, the week of her 70th birthday! And here she goes again, off on another adventure in a very "far-away land." Sharon

(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast).

8 Sept 2014
"We have a plan...fluidly speaking"

It seems odd that I've been here for only a month--so much waiting and wondering, so many plans changed, and changed again.

Let's see...Since I last wrote, our leadership finalized their
decision not to go to Benin at this time. The situation was just
too precarious, and there was too much chance that we would make the situation worse by inducing people to travel and congregate.

Next, we considered returning to the Congo, where we had our last field service. Unfortunately, the situation in neighboring DRC was also precarious--sources told us that it was much worse than was being reported. The government of Congo preferred that we not come into their port at this time, for the same reason--we are a magnet, and people will travel to get to us.

So, where are we going? The latest plan is...________(I'm not
allowed to say just yet). I must admit, this country wasn't even
on my short list of possibilities. Looking at the map, I discover
that it is very far away! The sail will be long indeed--all the
way down the west coast of Africa, a stopover in South Africa to
refuel and replenish our supplies, and then another sail up the
eastern side.

Usually, it takes months to get a protocol signed with a host
country, even a country where we've been before. For last year's
field service, it took a year to hammer out the details of the
protocol with Congo. It took two months to finalize the protocol
with Benin, a country where we've been five times previously.
We've never been to "country next" before, but with them,
negotiations began one weekend and were finalized and signed one week later. Seems like God has opened a door for us, doesn't it?

Dates...are quite tentative at this point. The target date for
arrival in country next is October 25. We will deploy an advance
team to work with the government and with the port authorities so that at least the legal stuff (protocols, visa waivers...) will be
done and essential services (water, sewer, trash...) will be
available. Much of what the advance team traditionally does will
not be done, of course, because they have only 40 days. It means a slower, more gradual start-up for the field service. We probably won't have an eye clinic building waiting for us, or day crew hired, or screening sites located. Other departments will be
similarly impacted. But, I hear that this is the way we used to
operate, so this is a return to old patterns of arrival, not
complete chaos.

Meanwhile, work on the ship continues. The engineers successfully replaced the O-rings in the propeller shaft, but unfortunately, sea trials to test that repair revealed a second problem, something with the side thrusters. I'm not sure what they will do about that. The delay to fix the propeller allowed time for other repairs, too. They've been working on something electrical--we've had several blackout periods while they worked--and other less critical repairs. Other departments are working on special projects of various sorts, too, so the extended shipyard time has not been wasted.

We are also awaiting the arrival of two containers. We shipped
containers to Benin, our usual procedure...but it takes two to
three months to get a container, and we didn't know what country
next would be in time to send containers there. 

When it rains, it pours. Now, our massive freezer went on the
fritz. That repair is likely to cost $100,000 and take eight days.
Even paying the shipyard workers extra to work the holiday
weekend, this will delay our departure for another two days. So,
our proposed departure date is now September 13--if all goes well.

Once repairs to the ship are sufficient for sailing and the
containers arrive, we'll leave the shipyard in Las Palmas to sail
for Cape Town, South Africa. In Cape Town, the plan is to do some PR work--lots of tours of the ship, etc.--while we wait for the advance team to do their thing in country next.

We may also need to go into dry dock for repair of the side
thrusters. That is a bigger deal than just shipyard repair. You
have to lighten the ship of fuel and water and relocate all the
families with children to somewhere off the ship. We can't do it
here because we've already taken on too much fuel. The problem is, we're having trouble finding a dry dock with space for us in Cape Town. So, as you can see, plans and dates are still pretty fluid, developing and changing daily.

Faced with the prolonged sail, many people who came to help with the beginning of field service in Benin are going home early. Lots of goodbyes, and lots of rearrangements of staffing to cover the holes. I expected to work in the dining room for 2 weeks before transferring back to my "real" job on the eye team. I'm still in the dining room, and probably will be until late October. It is hard work, but not as hard as working in the galley or on deck crew. I get exhausted, but it is a good team to work with, and others do the really heavy lifting and mopping so I don't have to.

I appreciate their consideration!

All these details are not as fascinating as patient stories, but
perhaps it paints a picture of just what a complicated operation it
is to deploy the Africa Mercy to do those surgeries. Usually, all
that preparation happens smoothly in the background and doesn't get noticed, even by those of us who serve on the ship. Watching as these changing plans develop has made me appreciate all the more how many issues must be resolved to make a field service possible.

Now, if all goes according to the latest plan...I will celebrate my
70th birthday on the high seas, on my way to South Africa. My
chair might be rocking, but its not a "rocking chair." I'm on my
way to adventure in a far-away land. How crazy is that?

Marilyn Neville

[Click here to learn more about the nurses and doctors on board the Africa Mercy.]

Africa Mercy - Now What? One Nurse's Journey

August was a a month of unknowns for the Africa Mercy, when and where it would go. Read more about the ongoing Ebola crisis. Sharon

(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast).

25 August 2014
"Now what?"

In the normal course of things, we spend a couple of months in Gran Canaria for shipyard maintenance, and then we sail to Tenerife (another Canary island about six hours away) to restock supplies before sailing to our next field service.  This summer, the ship did in fact get its scheduled maintenance and then sailed to Tenerife.  (That's where I rejoined the ship.).  Plans changed when Ebola hit Nigeria; we delayed our scheduled departure for Benin for a couple of weeks to watch the developments.

Meanwhile, on the sail between islands, we discovered a problem with one of our propellers.  As a result, the ship had trouble going forward and trouble stopping--probably something that should be attended to, right?

It turned out to be quite a puzzle.  For two weeks, the engineers hunted for the problem. Finally, digging deep into the guts of the thing, they discovered that a couple of O rings were defective.  Replacing O rings sounds easy--but we're talking about massive equipment buried in the bowels of a ship.  To repair it, we had to sail back to the shipyard, and they say it will take two weeks of work to dismantle and repair the propeller.  And so, now it will be at least another week of delay. Tentatively, they hope to sail to Africa around September 5th, if all goes well.

If you've been following the Ebola crisis, you know that the problem has been escalating dramatically.  Previous outbreaks have been located in small rural villages, where they were quarantined, stayed local, and petered out. This outbreak is in major cities, in populations that are mobile, and it just keeps growing.  Guinea seems to be leveling off, finally, but Liberia's problem has gone exponential  I can scarcely imagine the horrors going on there. It reminds me of the Black Death that ravaged Europe in the Middle Ages.  (Well, it's certainly not THAT bad yet...)

Lagos just reported two more cases, and they are second tier, one step removed from Patrick Sawyer's caregivers.  I was very much hoping that Nigeria had reacted quickly enough to contain the outbreak to include only those who were initially exposed to Patrick.  Now that it's gone to another level, will they be able to contain it at this point?  It seems very touch and go to me.

Both Uganda and Democratic Republic of Congo have now reported cases of Ebola, but apparently they are independent outbreaks of different strains, not a spread of the West African strain.  Possibly it is "business as usual" for these countries, where outbreaks occur most years in rural areas and are contained with quarantine.  Perhaps it is only our awareness of the problem that is different.

So, when and where are we going?  How will we conduct business once we are "there"?  Will we do mass screenings, or find patients some other way?  Etc., etc.  So many questions...and no answers yet.  And so, we wait and pray.

Marilyn Neville

[Click here to learn more about the nurses and doctors on board the Africa Mercy.]

Africa Mercy - Delay, Decisions Pending: One Nurse's Journey

Another August post from Marilyn. I'm glad the Africa Mercy is taking precautions regarding the Ebola crisis. I love that Marilyn's humor is fully intact despite delays. Would love a picture of that red hair! Sharon

(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast).

August 14, 2014
"Delay, decisions pending"

Dear friends,

Well, we were supposed to sail for Benin tomorrow. Last Monday, they announced a two week delay, and a possible change of plans, due to the Ebola outbreak in Nigeria. The management of Mercy Ships is watching the situation very carefully; they feel that it will become more clear within a couple of weeks, either for better or for worse. Meanwhile, they are looking into alternatives, whatever that means.

We are a mobile surgical unit, not a general hospital equipped to
handle infectious diseases. We cannot really help in the
management of this outbreak, but we sure could make it worse if we show up in the wrong place. Many Africans mistrust their own hospitals and medical system; our big white hospital ship would draw desperate people like a magnet, hoping against hope that we could help them, no matter how much publicity we put out to say otherwise. Lagos, the city in Nigeria where the Ebola outbreak is located, is only about 60 miles from Contonou, Benin, where we would be, and the border between the two countries is quite porous.

If we tried to screen for surgical candidates and a few Ebola
sufferers show up, mixing with the crowd, well,...not pretty.
Choosing an alternative destination is not so easy, either.
Normally, we have an advance team in country for a year prior to the ship's arrival. They work out the agreements with the
government and arrange for necessary goods and services. They do publicity to alert the population so that we have patients waiting for us. They find suitable facilities for the dental and eye
clinics, and for the Hope Center (our housing for post-op patients who need more rehabilitation) and get the buildings renovated, ready for use. They hire the day crew that we'll need and start their training. A lot happens behind the scenes before we ever arrive. This work has been done for Benin, but of course, not for "somewhere else."

As you can imagine, even a two week delay causes quite a lot of
disruption. Many volunteers planned to arrive in Benin shortly
after the ship arrived, in time to help with the big screening day.
Those plans no longer work, and those folks are left hanging, not
knowing where or when to come. Others planned to leave from Benin during our first two weeks, and obviously our ship will not have arrived in time for them to catch their flights. I can only
imagine the disruption to the advance team and to the day workers in Benin who are poised for our arrival.

For those of us already on the ship, this is a time of waiting for
the shoe to drop. There are tasks to be done, but we're eager to
be about the business we came for. The uncertainty about the
future isn't terrible, and we have great confidence in our
leadership as they face difficult decisions, but it is unsettling
to wonder what will become of us, what we will in fact be doing in the coming months.

To end on a funny note--my hair is turning orange. It seems that
they cleaned the water storage tanks this summer, and much rust is still coming through the pipes. Gee, I've never been a redhead
before...wish it were a bit more auburn, not so...rust-colored.

Marilyn Neville

[Click here to learn more about the nurses and doctors on board the Africa Mercy.]

Africa Mercy - Return to Ship, Ebola Status: One Nurse's Journey

Hi! Some of you have been reading about my friend Marilyn's journey on the Africa Mercy. After a three-month vacation back home, she returned to the ship in August, only to face complications from the Ebola outbreak. As I am behind in my blogging schedule (still moving into my new home), I will post these back to back (as they came to me). Sharon

(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast).

August 07, 2014

Hello again,

After three months of wonderful visits to family and a few friends, I returned to the Africa Mercy yesterday. We are currently docked in Tenerife, one of the Canary Islands. The ship undergoes maintenance and repairs between each field service, and shipyard was in the Canaries this year. After one last repair and some loading of supplies, we plan to sail to Benin around the middle of August. For those of you who are as ignorant of African geography as I am, Benin is a little country located right next to Nigeria, on the underside of the big bulge that constitutes West Africa. Of interest, it is also located about 500 miles away from Liberia, Sierra Leone and Guinea, the epicenters of Ebola.

I'm sure many of you are following the Ebola outbreak with some interest and concern. It certainly looks scary! That it was spreading didn't surprise me--those countries are so crowded, with poor sanitation, less awareness of infection control measures, and inadequate protective equipment available to health care workers.That a couple of American health workers were infected really caught my attention because I KNOW that they took proper precautions. If they caught it, then...

Some of you may wonder why we're not responding to the crisis by sailing to the epicenter to help in the fight against Ebola. The fact is, we are a surgery unit, not a general hospital, and we are not designed, equipped, or staffed to deal with infectious diseases, or any other health problem, except certain types of surgery.

Some of you have expressed concern for the mission and people of Mercy Ships in the face of Ebola. Mercy Ships recently issued a public announcement saying, in effect,"we're aware, we're watching, everything's cool." Of course, they spent more words than that, but you get the gist. (see attachment if you're interested) Department managers get more of the inside story, and in conversation with one of them today, I learned a few details of what "we're watching" means. It sounds like Mercy Ships has developed detailed plans, with specific trigger points identified and response actions prepared. Of course, I don't know what the trigger points are, but I do know that those in charge are proceeding with all due diligence.

It is a comfort to me to realize that Mercy Ships is an old hand at dealing with in-country crises of various sorts. When we were in Guinea, there was a lot of unrest, and even violence, in the city where we were located. Mercy Ships had detailed plans then, too, of what our response would be if this, or if that, or if the other. What if we had to leave and we had patients on board who couldn't be discharged? Mercy Ships had a plan and had already made all the necessary arrangements, so they could have responded almost instantly if they had needed to. I'm sure that that kind of planning is taking place in the current situation, too.

Mercy Ships has a crew of volunteers from many nations, including quite a few from Guinea, Sierra Leone, and Liberia. These folks are obviously much more directly impacted by the Ebola crisis than those of us from "safe" countries. They have family and friends who are in harm's way. Some of them may need to go home, but if they do, they can't return to the ship until they've been in quarantine on shore and free of fever for 21 days. (In general, Mercy Ships has a ban on anyone who has traveled through those countries any time recently.) It must be very hard for our African crew to watch this plague envelope their countries and be unable to help.

For the moment, anyway, we are proceeding on schedule to Benin. The plan is still to have the major screening day on September 9. Between now and then, there is a lot of preparation work to be done. Cleaning the hospital after shipyard repairs is underway now, but most restocking and moving stuff will need to wait until we land in Benin. You never know when you'll hit rough seas while sailing, and everything needs to be tied down tight until we arrive.

For now, I am working in the dining room (no eye surgeries happening, of course, so hospital personnel get reassigned to a temporary job for the duration). Each day brings more volunteers back to the ship--our population is growing from a skeleton staff of about 100 during shipyard to probably 300 before sail, and another increase to about 400-450 between the time we land in Benin and the time of the big screening day. Lots of hellos and goodbyes in this time of transition.

So, goodbye for now. I'll keep you updated if there are significant changes in plans, or if something interesting happens.


(Attached Notice: Africa Mercy Public Announcement)

05 August 2014 UPDATE

As its hospital ship, the Africa Mercy, prepares to leave for its ten-month mission to perform life-changing surgeries and train local healthcare professionals in Benin, West Africa, Mercy Ships continues to be acutely aware of the Ebola situation in the region. The organization is taking appropriate steps to protect its volunteers and staff. In April, Mercy Ships redirected its upcoming mission from Guinea to Benin out of caution for the safety of its crew. Benin has no reported cases of Ebola.

The Africa Mercy is the world's largest civilian hospital ship, designed to operate as a surgical specialty hospital. It is not configured to provide the type of treatment required by Ebola patients. In addition to having changed its itinerary, Mercy Ships has also implemented strict travel restrictions to the affected areas and will continue to monitor the situation closely, making programmatic adjustments as needed.

Founder Don Stephens commented, “The well-being of our patients and dedicated crew is our greatest priority. It is fundamental to our continued service to the forgotten poor in Africa. Our prayers go out for the countries impacted by Ebola. These are places and people we know well because we have served them in multiple visits over more than two decades.”

[Click here to learn more about the nurses and doctors on board the Africa Mercy.]

Sharon M. Himsl

Writer/Author. Blogging since 2011. 
Published with Evernight Teen: 
~~The Shells of Mersing

About Me

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You could call me an eternal optimist, but I'm really just a dreamer. l believe in dream fulfillment, because 'sometimes' dreams come true. This is a blog about my journey as a writer and things that inspire and motivate me.