Video recap of Madagascar part 1

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This fantastic video made by the communications team aboard the Africa Mercy gives a quick recap of all the wonderful things that happened earlier in the year in the first field service in Madagascar. Part two is now well underway!  It will give you an idea of some of the programs going on, both on board and across the country, and will give you an idea of how our Surgical Safety training team fits into the bigger picture of how Mercy Ships is working alongside health care professionals across Madagascar. Very exciting stuff!

Surgery on board started this week, and I have never been so excited about the start of surgical lists – just metres from my cabin!

Bricks and building

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Rice fields surrounding Antananarivo, rice on the menu 3 times a day here!

A lot has happened in the space of a week!

Since landing in Madagascar on Thursday night, I’ve enjoyed a beautiful bus ride along the convoluted but spectacular road from the capital Antananarivo to the eastern port town of Tamatave AKA ‘Taomasina’ -all of the towns here have both French and Malagasy names which can get confusing! You can follow our travels on an interactive map as I move about here.

In 2 days waiting for the Africa Mercy and her crew, those of us waiting in Tamatave had a chance to share stories and sample the excellent local food! Here are some new friends who will be working in housekeeping, rehab and nursing teams from US, Sweden, and Liberia.

Girls on the dock

Picture courtesy of Sherri Hawkins-Thompson, bottom left – a very serious character! I will remember to take more pictures myself soon, promise!

On Sunday Morning the Ship arrived with much celebration on deck and dock alike. Ship arriving

On board at last

Since the ship’s arrival, there has been a whirlwind of activity. The amazing crew have embarked well over 100 new crew, not to mention over 200 local ‘day crew’ who support just about every area of operation while we are here.

Before we even arrived, the ‘advanced team’ have been working hard preparing alongside local authorities, renovating hospital buildings and accommodation, hiring the day crew, meeting and working with officials, even setting up donation text systems with the 3 local telephone networks so that Malagasy people can donate to the patient transport fund. Not to mention that in the first of 10 screening sessions planned across the country, the screening team have already seen over 2700 patients in the capital screening for patients to come for surgery.

I am utterly staggered by the enormous diversity of skill, depth of experience, and unrepressed excitement to serve others displayed in everyone I have met in the last week; from ship engineers to ward nurses, translators to kitchen crew to the chaplains (who seem to have learned the names of hundreds of new people in a matter of days).

Building bricks

Driving out of Antananarivo you are entirely surrounded on either side by two recurring themes; where it is wet, there are rice fields (as at the top of this post). Where it is dry, there are bricks. Everywhere you look, as far as you can see, people are fashioning bricks, drying bricks in enormous kilns, stacking bricks, carrying bricks. The Malagasy people are pretty serious about building it would seem!

bricks

My friend Chelsea took this as I was too far from the window, which is why my reflection is appearing in the sky like Simba’s Dad in Lion King.

In some ways, people are a bit like building bricks. Each of us occupies a unique position, leaning on those around us and supporting others in such a way that things would not be the same without us. We all need each other.

I also have been reflecting on WHAT it is we are building together. Projects and programmes aside, this is all about people. Nothing of lasting worth can be built without investing in people. The Medical Capacity Building team will be working together to serve and equip our colleagues in Madagascar by bringing a 3 day course to 20 regional hospitals, delivering equipment and training which we take for granted in every operating room back home in the UK.

‘Follow the 2000 year old model of Jesus, Mercy Ships brings hope and healing to the world’s forgotten poor.’  Jesus didn’t invest in any physical buildings that I have ever heard about, but his life and example of investing in people continues to inspire this Ship’s team from all over the world to work together to serve the people of Madagascar.

This week is going to involve lots of work planning and preparing as a team for our first 3 day surgical safety course in the 2nd week of September.  

‘No man ever wetted clay and then left it, as if there would be bricks by chance and fortune. – Plutarch’

I guess that means I better leave you now and get on with it!

Landed

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 After 24hrs of planes and airports, (including many stop-over hours well spent in the Java coffee shop Nairobi airport, thanks Francis Woods!) I have arrived in time to be welcomed to Madagascar by this fantastic sunset over the road which runs through the middle of the lake in Antanarivo. I’m staying tonight with some lovely Mercy ships crew who picked me up from the airport, before the all-day bus extravaganza tomorrow to get to Tamatave and join the team. Slight delay in sending this, as we have just already had our first power cut!!

Plans and propellers

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President Dwight Eisenhower once observed that he had always found that ‘plans are worthless, but planning is everything.’

A few weeks ago, my plan for this particular moment involved flying out from Heathrow to join the hospital crew on board the Africa Mercy. However while the ship was docked in South Africa for routine maintenance, they discovered an issue with the port propeller shaft. Presumably, a massive ship with unilateral propulsion problems would end up doing the nautical equivalent of chasing it’s own tail! So there has been a necessary delay in the ship returning to Madagascar while this is all being sorted out.

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My new departure date of 26th August should coincide with the ship’s planned arrival in Madagascar, and although there probably won’t be time to join the operating team in theatres on board (at least for now), our team should be right on schedule to start the national surgical safety improvement project.

So plans may have changed, but the planning continues! In fact, in the last few days I have had the opportunity to meet up and plan with the other UK member of our travelling team – Ali Herbert, an Anaesthetic Nurse who has served with Mercy Ships many times before. I seem to have accidentally given her the impression that I will be going running with her at 5.30 in the mornings. This alarms me. I have bought new trainers.

It has also given me time to reflect on the principle expressed at the beginning of this post. In many ways, anaesthetic training encourages you to plan meticulously for unlikely eventualities. Ideally, in the very process of this planning, you equip yourself to acknowledge and deal with a constantly evolving situation, and prepare yourself to quickly abandon your ‘plan A’ if necessary.

Even if a plan may eventually be abandoned, the process of planning is valuable in itself, and the effort is often not wasted.

stay_cool

On a personal level however, it can be challenging to hold lightly to expectations, and not become disappointed or anxious if things don’t go as you expect. It is also not always straightforward to navigate the narrow boundary between prudently planning (which can help you focus, prepare, and clarify) and worrying fruitlessly about things beyond our ability to control. Worrying, rather than helping you move forward, leaves you going in circles like the dog after it’s tail, wearing ourselves out without actually getting anywhere.

‘Who of you by worrying can add a single hour to his life?’ – Luke 12:25

‘If a problem is fixable, if a situation is such that you can do something about it, then there is no need to worry. If it is not fixable, then there is no help in worrying. There is no benefit in worrying whatsoever.’ – Dalai Lama XIV.

I have a feeling that plans will need to be changed many times in the course of the next 6 months, especially with the amount of travel we will be doing on roads that are intermittently impassable in bad weather! But that is for another day. ‘Worrying is carrying tomorrow’s load with today’s strength – carrying two days at once. It is moving into tomorrow ahead of time. Worrying doesn’t empty tomorrow of it’s sorrow, it empties today of it’s strength.’ Thanks, Corrie ten Boom. For now, I will take today as it comes, and continue with planning, packing, and enjoying the unexpected gift of a bonus few days with family!

Surgical elephant in the global room

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I was once hospitalised with malaria after falling asleep 20 foot up a tree, as we all do from time to time right? …. No?… Just me. Ok. At the time, I was working with kids in Zambia whose lives and families had been devastated by the effects of HIV/AIDS. After returning to London I spent 8 months working with Infectious Diseases teams, and now just yards from the operating theatres where I currently work they treat wards full of patients with destructive diseases like drug resistant tuberculosis. The news regularly features alarming stories of the most recent outbreak of yet another potentially lethal transmissible illness.

Infectious diseases are a big deal.

So if I were to warn you of a ‘Global Public Health Crisis!’ I wonder what things would pop into your head?
Ebola? Malaria? HIV?

It is generally well known that these infections cause terrible devastation and loss of life around the world. Thankfully enormous resources have been poured into international public health initiatives to help prevent and treat them in recent years. The recent ebola crisis (photo above courtesy of MSF website) was partly responsible for my decision to take time out of NHS training to volunteer overseas.

What is less well known, is that far more people around the world die from a lack of safe surgical care than from HIV, tuberculosis and malaria combined.

So hands up if lack of access to safe surgery and anaesthesia was in your ‘global crisis’ list? It wouldn’t have been in mine either until recently, but the numbers speak for themselves.

Global fatalities in 2010:

  • HIV/AIDS        1.46 million
  • Tuberculosis   1.2 million
  • Malaria            1.17 million
  • Lack of access to surgery  18.6 million

All in all, around 5 billion of the world’s population do not have access to safe and affordable surgical and anaesthesia care when needed. More on that another time, but you can read the details in the Lancet 2015 Commission on Global Surgery here.

Catching malaria may not be something you can relate to.

However if you remember the last time that you (or someone close to you) needed surgery, just imagine what might have happened without it. Problems such as obstructed labour, broken limbs, appendicitis, a hernia are all treatable but could turn into potential catastrophes with high rates of fatality in the absence of safe surgical care.

This is why Mercy Ships not only bring the staff and facilities to provide life-changing surgery to those who need but can’t access it, they also work hard to build the capacity of local health care teams for the long term.

This is why the Mercy Ships team I join in 3 weeks will be partnering with Lifebox, who since they were founded 4 years ago have improved standards for more than 10 million patients in 90 countries through distribution of essential safety equipment and the volunteer-led training of over 3000 anaesthesia providers. We plan to do the same all across Madagascar.

This is why universal access to safer surgery is a vision worth supporting.

Welcome to my Madagascar blog!

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Hi! My name is Linden. From August 2015, I am taking a year off from my training as an anaesthetic doctor in London to work in Madagascar with a team from Mercy Ships and Lifebox. I will be posting updates and reflection on this blog as I go.

For the first time in history, you’re more likely to be killed by a surgically-treatable condition than an infectious disease. However millions of people around the world don’t have access to safe surgery and anaesthesia that can save and transform lives. Mercy Ships and Lifebox are two organisations working hard to see that picture change.

The charity Mercy Ships run the world’s largest non-governmental hospital ship, the Africa Mercy. She is staffed almost entirely by volunteers and brings medical care to some of the world’s poorest people.  I will be joining her during her second field service in Madagascar.

After 2 weeks in the operating theatres on board the ship, I will spend the next several months travelling in a small team of local and international volunteers from Mercy Ships partnering with the NGO Lifebox. We will be bringing vital medical equipment (including pulse oximeters which monitor blood oxygen levels- see below) and team training to hospitals all across Madagascar, supporting them in providing safer surgery and anaesthesia. If you would like to get updates please feel free to subscribe using the button on the right hand side of this blog! You should also be able to access updates via my twitter and Facebook accounts. Thank you for your support and I hope you enjoy the blog!