Africa Mercy - Milestones, Guinea, Update on Frank: One Nurse's Story

More from Marilyn in Africa....  Sorry these postings are so late! My friend, as you know, is in Africa serving as a nurse on the Africa Mercy. She emails me and I share her words with you. For those of you who know nothing of  Marilyn's story, the Africa Mercy is a hospital ship that travels the African coast with a crew of nurses and doctors. They come from all over to give of their time as volunteers. 



(December)

2017-12-09

"Milestone Patient"

Ten years ago, Dr. Strauss did the first surgery on the Africa Mercy.

Recently, he did the 30,000th surgery.  That's a lot of surgeries for

one ship!  I thought you'd like to see this famous patient.

--

  Marilyn Neville

2017-12-14

"Guinea is next"

     The Africa Mercy is planning to go to Guinea next year.  I was

     there in 2013, before the Ebola outbreak.  It was a poor country

     then; it is much worse now.  Ebola devastated the health industry,

     among other things:  it seems that the physicians and nurses either

     died or fled.   I have heard that there is no anesthesia machine in

     the entire country, which means no surgeries.  There are no

     ophthalmologists at all, and the once-thriving eye clinic in

     Contonou is barely functional now.  Furthermore, Ebola survivors

     have a host of eye problems as a result of the disease, including

     cataracts.  (27% of those with the disease did survive…)  It sounds

     like we will have our work cut out for us!  I am excited about the

     prospect of going to Guinea.  I have applied, but of course, I

     don’t know yet if they will select me as part of the team.  Stay

     tuned…

    Meanwhile, back in Cameroon, we are still doing surgeries and

    training surgeons.  Patricia is a Cameroon surgeon who has been

    training with Dr. Glenn Strauss for the last several months.  She

    had never actually done surgery before she came to us, but she

    caught on quickly and has become pretty proficient.  Not as fast as

    Dr. Glenn, of course…but who is?  She plans to set up a surgical

    clinic in the northern part of Cameroon, in an area that currently

    has no eye surgeries available.  Mercy Ships plans to equip her with

    the surgical tools she needs and send her off with our blessing

    soon.  Starting in January, we will have a new Cameroonian trainee,

    one who plans to operate in Douala or Yaounde, I believe.  It’s one

    thing to blow into town and do surgeries; it’s another to invest

    time and resources in the surgeons who will remain after we leave.

    Of course, not all countries have the health infrastructure to allow

    a surgeon to thrive, but Cameroon does.  (Guinea doesn’t…no training

    program next year.)

     The rainy season is over, followed almost immediately by the

     harridan wind season.  We’re pretty far from the Sahara Desert, so

     we don’t get sandstorms, just dust.  It looks like a permanent case

     of LA smog out there.  We haven’t seen the sun in days.  It does

     keep it cooler, though.  It is merely “overcast” hot and humid

     instead of truly tropical-African hot and humid.  Works for me!

     I’m surprised we don’t see more lung problems, though, if they

     breathe this dust every year.  Maybe this dust isn’t corrosive like

     smog, and our little lung cilia are able to keep up.

     The patient on my heart today is a man I had to deny surgery

     yesterday.  His eye qualified for surgery, but his foot didn’t.  He

     asked a good question, “What does my foot have to do with my eye?

     Why can’t you do surgery?”  But the risk of his spreading the

     infection from his foot wound to the newly operated eye is

     significant, and that would be devastating to his eye, destroying

     what vision he does have, and if not treated aggressively, maybe

     even worse consequences.  I encouraged him to see a doctor, get his

     foot properly treated with antibiotics, and come back to schedule

     eye surgery when the foot wound is not infected.  I only hope that

     he is able to afford to do that, and I hope that he heals in time

     to be scheduled.  He’d had the wound for many years, and he seemed

     pretty discouraged.  I’m such a softy, I probably would have

     explained the risks and allowed him to choose to have the surgery

     anyway…but I’m not the surgeon, and it’s not my call.  On the other

     hand, I had just such a patient two weeks ago, with a

     long-standing, infected, non-healing leg wound.  I gave him the

     same instructions, and he did what I suggested.  He returned this

     week to show me his now-healthy, now-healing wound; I got to

     schedule his eye surgery!  Maybe yesterday’s patient will do

     likewise.

I've included a picture of Dr. Patricia doing YAG under Dr. Strauss'

supervision.

 --

  Marilyn Neville

  

2017-12-22

"Update on Frank"

Good news!  The Communications Team visited Frank again recently.  Remember how, before surgery, Frank wouldn’t smile for love nor money?  He was so depressed, with a hopeless-looking future.  Well, this visit, he never stopped smiling.  He was so joyous, so full of life and hope.  Before surgery, he was completely blind.  He couldn’t go anywhere unless someone led him by the hand.  He couldn’t do much of anything; he certainly couldn’t hold a job.  He lived in a very small world—his home, a one-room shack with no door.  Remember how disappointed we all were immediately after surgery, when he didn’t get the dramatic improvement that we expected?   Well, it seems that his vision is still slowly improving, at least somewhat.  He now has “count fingers” vision—still rated as blind, but considerably more useful than nothing.  He can walk independently, a freedom he treasures highly.  He is gradually venturing further and further from home by himself.  In fact, he is now looking for a job!  I suppose he could be focused on disappointment, that his vision is still very poor after such high hopes.  Instead, he has chosen to be thankful and to treasure what he does have.  He could be the poster child for an anti-grumbling campaign.  Certainly, he blesses me by his example.  Pretty nice Christmas present, don’t you think?

--

  Marilyn 

   

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.

Marilyn

(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

Africa Mercy - Goodbye Congo: One Nurse's Journey

A parting post from Marilyn in the Congo, as she prepares to come home for a break. Those of you following the Ebola outbreak in Guinea will find this
interesting. .....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).





Goodbye Congo
11 April 2014

Our time in Congo is fast drawing to a 

close. Because of the long follow-up required after cataract surgery, we have to stop surgery several weeks before the ship leaves the country. In fact, our last day of cataract surgery was yesterday. We will do some pterygium surgery next week because the follow-up is not so long for them, but after that, my job is done. The ship leaves Congo around June 1, but I will be leaving Apr 23rd, headed for the good ole USA and visits with family and friends.

As I was thinking about this email, a band of about 30 minstrels marched slowly up and down the hall outside the hospital wards, singing at the top of their voices, some of the dancing a bit, all of them harmonizing and moving from one praise song to the next without missing a beat. 

They were dressed in hospital gowns, and each carried a Foley bag (collects urine from a catheter). Who was this strange choir? The VVF ladies! VVF stands for vesicular vaginal fistula. This is a condition that can happen to a woman as a result of a long, difficult labor without proper medical attention. The baby's head presses so long on surrounding tissues that some of them die, leaving her internal plumbing a mess.


Many women die, of course. I've heard that one in ten women around here do die in childbirth. Many others survive, but with scar tissue and fistulas between the vagina and bladder and/or bowel. The incontinence makes them social outcasts. Husbands move on. Families put them in a shed out in back to sleep and eat and won't let them come into the house. It's not a nice life. 

Then Mercy Ship comes, and they get repair surgery. Recovery takes weeks, and the women are with us at least until the catheter can be removed. So our wards are brimming with very happy, hopeful, thankful women. No wonder they march up and down the hall several times a day, singing their thanksgiving and praise to God. We give each woman a new dress before she leaves to celebrate her recovery. I'll try to attach a photo of some of our decked-out ladies.

 I think I told you about the edict that we will not do eye surgery on anyone whose blood pressure is over 200/110. This is Africa. Probably half the population over the age of 40 has high blood pressure, and most of them don't take medication for it. We tell them to see their doctors and get on medication before surgery. We call them to remind them to take their medication before they come to the ship for surgery. But, pretty much every day, we have several people arrive with pressures over the limit. We tell them to take their medication if they've brought it with them; we tell them to relax, even take a nap. But mostly, we pray.

An amazing number of times, their pressure will eventually dip low enough to allow surgery...and then immediately rise again once we're finished. It feels like God's blessing, parting the "sea" to rescue these people. I can almost hear him chuckling, "I want these people to get help, so I'll make it possible, and never mind your rules."

One such fellow was our very last patient yesterday. He arrived early in the morning, as scheduled, but his blood pressure hovered around 230/125. He is only 50, but he has dense cataracts in both eyes. He could see hand motion, maybe even count fingers held in front of his face, but he is a teacher, and he needs better vision. He'd taken his medication as directed. He took a nap. Still, his pressure remained above the limits. 

He waited on the dock all day, and every time we brought a patient out after surgery, we'd check his pressure again. It dipped slightly, to about 210/115, but time was running out. We checked about 1:30...nope, still too high. Did he want to give up? No, he'd wait some more. More prayer. Finally, about 3:30, it dipped to 198/110. We rushed him onto the ship and did a fast prep for surgery to get him in as last case, just in the nick of time. It was a beautiful finale to our surgical year. Wouldn't it be fun to follow him home to see what a difference the surgery makes in his teaching and in his life?

As you know, we are supposed to go to Guinea for our next field service.

Now there's an Ebola outbreak in Guinea. We don't know if that will affect our ability to work there or not. Can you imagine a crowd of thousands gathering for our main screening, and then an epidemic breaks out? Ebola is spread by body fluid contact, so that's better than respiratory transmission when it comes to crowds...but hospital wards and surgical patients are abundant sources of body fluid contact. We have up to twenty patients, twenty caregivers, and half a dozen nurses and aides in a single room, and they mingle freely, use the same bathroom, etc. Mix in one Ebola patient... Well, Mercy Ships is studying the situation carefully, including our own on-the-ground assessments as well as WHO and other experts' input. They will make a careful decision and let us know.

Meanwhile, please pray for Guinea. It is quite possibly the most needy nation in our service area. They are too poor and too turbulent to attract foreign capital, but without outright war, they don't get international aide and rescue, either. Jobs are extremely scarce, and poverty is everywhere. Medical care is desperately needed. We always have more patients than we can handle every time we go there. It's like tossing the starfish back into the sea--you can't help them all, but you can make a difference to some. I really hope that conditions will allow us to go there next year. So...stay tuned...

Marilyn  











 




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