What is Mercy Ships?

They encourage people to put some disclaimer saying that everything posted is my own personal views and may not reflect the views of Mercy Ships. So there it is. Anyway, onwards.

Mercy Ships is an international faith-based organization that runs a fully-operational hospital ship called the M/V Africa Mercy, which I think is currently the largest hospital ship in the world. She is a big boat (formerly a rail ferry). She’s got six operating theaters, an intensive care unit, recovery and inpatient wards, imaging equipment, pharmacy, lab, … anything a hospital would likely need. It also houses the 450+ crew that is needed to keep it operational, including maritime, admin, hospital, housekeeping, galley volunteers. It has a small school onboard for children of missionaries who accompany them, and has a small café, convenience store, hair salon, launderette… things that keep a small town operating.

Over 50% of the world’s population lives within 100 miles of the coast. Of the 100 largest cities in the world, 90 are port cities. The ship allows us to bring a mobile modern hospital with reliable resources to under-served populations. For about ten months out of the year (August through June), they port with a nation (currently they serve nations in Africa) and provide free healthcare to the host nation. The other two months are spent elsewhere servicing and maintaining the ship. While docked, they provide free surgery, intensive care, and recovery on board. Ashore, they implement dental, eye, and primary care clinics, as well as educate and train the community in health care, construction, and agriculture to build up the public health capacity in the host nation. A crew of 400-450 volunteers from around 30 nations serves on board at any given time, and Mercy Ships hires locals to serve as day crew, who number about 200. Day crew helps with translations, cooking, housekeeping, and things that would help the ship serve its host nation better.

Medical Programs

Surgery

Surgery comprises the immediate, most dramatic medical help that we can provide. Oftentimes, since people do not have access to safe, affordable, and secure medical care, the conditions that people suffer from can often be extreme from years of non treatment. Severe deformities and malformations are often associated with witchcraft and curses, so people who have them are often outcast, shunned, and unable to hold jobs because few people are willing to employ them. They can be painful and functionally life-limiting, and the aim is to be able to restore their ability to thrive by removing public stigma and also showing people that these conditions are not a result of witchcraft, but rather medical conditions that can be treated.

General Surgery

General surgery includes hernia repair, goiter surgery, and removal of other lumps and bumps. It’s pretty straightforward; there isn’t much difference from the types of cases you see here as you would elsewhere, but a lot of the lumps can be quite large from years of non-treatment, like other tumors.

Maxillofacial Surgery

Maxillofacial (or “max fax”) surgery addresses facial tumor removal and cleft lip and cleft palate corrections.

We are only really able to treat benign tumors, as they are much less likely to recur and require subsequent surgeries for removal. I’ve found that most of the facial tumors that Mercy Ships treats are mandibular tumors, and the surgery requires that the jaw bone is removed. It’s then replaced with a titanium plate, which is then covered by a bone paste (sourced from the hip) to reduce the irritation of the foreign body in a follow up surgery. They have other follow up surgeries after their face has healed to remove excess skin that may be left and other cosmetic touch ups. The tumors can grow to a point where eating, drinking, and even breathing can become difficult. They can grow to enormous sizes from years of unchecked growth (Mercy Ships recently released the story of Sambany, who had the largest tumor that Mercy Ships has removed so far—16 lbs.).

Cleft lip and cleft palate is a congenital defect that results in the incomplete closure of the lip or palate in the mouth. Its cause is unknown in most cases. It results in the mouth and nose being one continuous cavity, and usually results in malnourishment because the baby is unable to suckle and breastfeed. Mercy Ships has a dietician who also specializes in ensuring that our infant patients are able to get the nutrition they need so they can gain weight to have the surgeries done. Typically cleft lip can be corrected in their first few months of life, but cleft palate must wait until they’re a little older (about a year, I think?).

Pediatric Generalized Special Surgery

Pediatric generalized special surgery is a relatively new area that has been developed that is meant to help correct other life-limiting congenital defects. The specialty is small and more difficult to recruit patients for as most babies who are born with severe congenital defects typically cannot live long without medical treatment. As such, most of the cases that we would see to treat would be cases of timing—where the ship arrives just as the need arises.

Pediatric Orthopedic Surgery

Bow-leg, knock-knees, windswept-legs (legs bowed in same direction), and back knee are all conditions that Mercy Ships corrects surgically during ortho season. Typically these patients have to be pediatrics (I believe the cutoff for Mercy Ships is under 15 years old) because their outcomes are much better with their bone healing and rehabilitation potential. In some cases, they are not painful, but in some cases, it becomes impossible to walk or move.

Reconstructive Plastic Surgery

Reconstructive plastic surgery (or just “plastics”) typically sees a lot of patients who have burn scar contractures or tumors (especially neurofibromas) that are growing in places other than the face.

Many of the people who live in West Africa cook over open flame, and it creates a much higher risk for severe burns. I’ve found that most of the burn patients we see are people who had accidents while cooking, including children who are playing and fall into the flame. Without immediate emergency treatment, the burns can scar up can essentially “fuse” a patient’s limbs together, rendering them unusable. After surgical release of the contracture, there is often a need for extensive rehabilitation since years of immobility causes the muscles to permanently shorten and contract.

Women’s Health Surgery

Women’s health surgery focuses on repairing obstetric fistulas, which is a condition that rarely happens in the developed world. When a woman tries to give birth, a hole develops in the birth canal, and usually the baby is stillborn as a result of obstructed and/or prolonged labor (labor can last for several days). It is preventable by having a C-section, which is not easily accessible or affordable. Women who have obstetric fistulas develop chronic urinary or fecal incontinence, and are shamed and rejected by their husbands and community because of the constant dripping of urine, feces, and/or blood results in a foul smell. They are unable to bear children, which is devastating for women who live in a society where a lot of their worth is determined by their ability to have and raise children.

Besides treating the physical issue that these women face, Mercy Ships also provides a safe, loving, and accepting environment to help them heal the emotional, psychological, and spiritual wounds that resulted from their conditions. There is a beautiful dress ceremony held for all the women in the program, where they are given a new dress and hat and there’s a lot of singing and dancing as well. :) They also can go through a program that helps them become more independent and equips them to help women back home as well.

Ophthalmic Surgery

Cataracts is the leading cause of preventable blindness in sub-Saharan Africa. In the developed world, it’s considered an issue of aging, but it affects children and adults alike in the developing world due to poor eye health and protection. Children can be born with congenital cataracts, and this greatly reduces their chances of surviving their childhood. Mercy Ships offers cataract surgery to restore sight to patients, and provides education to the community on optical health.

Non-Surgical

Not all of the services provided are surgical. Mercy Ships also has a dental care program and started a palliative care program for patients whose conditions are too advanced or terminal to treat by the ship’s services.

Dental Care

Things like toothbrushes and toothpaste are luxury items in many developing areas, and most people haven’t seen a dentist. Typically dental care is just allowing a tooth to rot, then pulling it, so there is a lot of teeth pulling happening here (as well as denture-making). There’s also a ton of education happening on how people can better take care of their teeth, and how they can save their teeth by having cavities filled.

Palliative Care

One of the sad realities is that not everyone who comes to be seen by the ship is in a condition to be treated by the ship’s services. In many cases, they may have conditions that are too advanced for treatment, or malignancy of tumors prevents us from being able to provide meaningful physical help.

The palliative care team is trained to assist in end-of-life care. They make frequent visits from every two weeks to every day to the homes of patients to provide palliative care, pray for them, worship with them, and provide education and training to families to find new sources of income for families who lose their primary breadwinner.

I had an opportunity to speak with one of the palliative care chaplains here on the ship. His name is Ernest. He has some interesting stories. Let me know if you want to hear them!

Medical Capacity Building

Another really cool thing that Mercy Ships does is what we call Medical Capacity Building (MCB). The idea is that if we can train the local health providers to do the things that we do on the ship, we can ultimately help improve the overall health of the nation long after we leave.

The main thing that drives MCB is “training the trainer.” We select several promising people to train, who then in turn go back to their hometowns, clinics, and hospitals to train others. One example is that on a previous field service to Guinea, there were hundreds of patients who came to be screened for cleft lip and cleft palate surgery. Mercy Ships trained two local surgeons to perform the surgery, and hooked them up with The Smile Train, a charity that funds the surgeries. On the return field service to Guinea six years later, only six patients came to be screened for cleft lip and cleft palate surgery! It was really amazing to see the fruit of the MCB team’s labors. People who receive this training will start marketing trainings to people of surrounding communities (and countries!) and build the capacity by several fold times. Usually people go for an initial training, then the team returns for follow-up training to see how they’re doing weeks or months down the road. Mercy Ships also invites people who were trained in previous field services to come back and serve with the crew during field services in other nations.

Mercy Ships provides training courses for locals in many areas, including safe surgery, essential pain management, obstetric and pediatric anesthesia, primary trauma care, essential surgical skills, neonate resuscitation, sterile processing, biomedical technology (clinical engineering), nutritional agriculture, and medical mentoring.

What will you be doing?

I will be serving for four months (beginning of December through end of March) on board the Africa Mercy for their mission in Conakry, the capital of the Republic of Guinea, in West Africa. There, I work in the hospital laboratory as a medical laboratory scientist with three other lab techs to perform the diagnostic testing required to help care for the patients we treat. The lab is open during day shift only, and the techs rotate being on-call after hours.

So, what will you be doing? ~nerd edition~

Though I only work in microbiology here at home, I do a lot more than that. The laboratory covers microbiology, hematology, chemistry, and immunohematology (blood banking).

They only culture for aerobic bacteria and use MicroScan for ID and sensi. Unfortunately, no MALDI-TOF is on board ;) so they use spot testing to help with identification. They do a loooot of O&P exams, so there’s a lot of parasitology to practice. Malaria detection is done by EIA, so not much (if any) blood film reading is done since it’s difficult to train and most people don’t have experience reading them. Malaria risk of infection is high in all of Guinea (>85% P. falciparum, 5-10% P. ovale, rare P. vivax), so I’ll definitely need to be bringing prophylaxis. I’m told a few crew members got it last year, yikes.

Hematology and chemistry is automated. They use the Abbott Emerald analyzer for hematology, which is a basic but comprehensive cell counter that performs 3-part differentials.  For chemistry, they use the BioMerieux MiniVidas for immunoassay testing (thyroid levels, HIV confirmation, Hep B titers and a few others). For general chemistries (electrolytes, liver and kidney function, lipid panels, etc.) they use a Fuji model that uses dry slides for each test.

Blood banking is done with the tube method, oh boy! ᕕ( ᐛ )ᕗ And they do get antibodies once in a while, but it looks like the antibodies will be a bit different in frequency than the ones we encounter in the United States. The coolest part is that they don’t keep many units on board—the ship crew acts as a “walking blood bank,” so the people are the blood units (they transfuse whole blood). The lab is in charge of making sure they have donors available when needed and is charged with collecting and processing blood units. We make sure that we have the appropriate units and enough donors on board at any given time so that we can be prepared for blood needs. Since we transfuse whole blood, it must be type-matched, though we can pack cells in emergency situations.

For the curious, here’s our basic test menu: