It had been almost 48 hours of nonstop travel from Montreal to reach Madagascar. Missed flight? Lost luggage? An experienced traveller, pediatric surgeon Dr. Sherif Emil, FRCSC, was nevertheless exhausted and unsure of what to expect when he finally arrived at the Africa Mercy, his home for the next two weeks.
A floating hospital, it intrigued him. That interest had sustained him throughout the long journey. Now, he wondered, would his work there have the lasting impact he hoped for, or suffer from the same challenges as other short-term medical volunteer trips?
His question was quickly answered.
“The moment I stepped on the ship, I felt that I was part of a very special environment. Everybody is really glad to be there; it’s a true community. That is the first impression you get before you even see a single patient. It’s very uplifting.”
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A ship with a mission to serve patients
Mercy Ships utilizes the coastline of Africa to access some of the world’s poorest patients. Docking in one port for 10 months at a time, the ship’s team provides life-changing surgery, post-operative care and engages in local capacity-building efforts. It’s what Sherif calls a “unique model of global health.”
He explained, “I’ve operated in Zambia and Tanzania, Kenya and Rwanda. You have the surgical skills, and you can sometimes get around a lack of equipment but it’s the post-op care that has always been our dilemma. We can do these cases but then there’s no neonatal ventilator or antibiotics are out or you can’t get a lab test done, so you get suboptimal results. That’s very different on the Africa Mercy.”
Aboard the ship, patients have access to state-of-the-art equipment, experienced surgeons and excellent nursing care, both pre- and post-surgery. A lot of preparation goes into selecting patients. Even before he leaves for a mission (he’s now on his third) Sherif is involved in reviewing cases, looking at photos and planning his surgical tactics. This provides him with familiarity for his patients, even before he meets them. Once on board, he will do about 4-5 operations a day.
“The ship has a very responsible way of going about things. They target things they have prepared for and that they know can be done safely with the resources that are available. They will not engage in surgical adventures. That is one thing I really appreciate,” he said.
Sherif normally operates on a variety of pediatric surgical problems, more often than not presenting at late stages. Large soft tissue tumours and congenital tumors, such as sacrococcygeal teratoma, can be the most challenging. Similar to his practice in Montreal, repair of abdominal wall hernias are the most common operations. On the ship, however, these operations can be quite complex due to chronic incarceration.
“In Canada, if a child came in with an incarcerated hernia and there was fear of bowel loss, they would go into surgery quite quickly. But patients in Africa can die of a strangulated hernia. It’s considered a lethal condition because often they won’t get treatment in time and their bowel will die and it will kill them.”
Paulinah vs. the monster
They said look at this baby. See if this is something you’d be willing to do. And I clicked and opened the file and I literally stepped back.
Five-month old Paulinah had a sacrococcygeal teratoma. The fact that she was alive and that her mother had survived childbirth astounded Dr. Emil. He operated on Paulinah during his first Mercy Ships mission to Madagascar in 2016 – the first time this type of surgery took place on the ship.
“If I were to have gone all the way to Madagascar just to look after her, it would’ve been enough. She was really a living miracle.”
A ship with a mission to build local capacity
“The Africa Mercy ship is really invested in capacity-building,” Sherif explained. “One of the needs assessments that the advance ground team will do is to consider where they can have a local impact. For example, is there a hospital that can be refurbished? Is there an operating room that can be remodelled? These are some of the projects they leave on land. Then they have CPR classes and WHO checklist classes for safe surgery, and training on how to sterilize medical equipment and proper sterilization techniques… there’s almost as much work done off the ship as done on the ship.”
Mercy Ships also brings in local surgeons to help operate and hires local people to assist with other work while they are docked.
“I was really moved on my first mission when they came to me, as I was preparing to head back to Canada, and asked if I would like to contribute to a special fund for the Malagasy employees. I was amazed that they were thinking ahead about what will happen to those people working with us after we leave and funding efforts to support them.”
This month, Sherif will leave for his next mission with Mercy Ships. For the second time, he will be taking a surgical resident with him. He’s excited to expose his resident to this surgical experience and to the dynamic of a team all oriented around a common mission.
“That’s really the spirit of Mercy Ships. People feel very privileged to be there and to contribute in any role. As Don Stephens, Mercy Ships founder says, ‘people pay for the privilege of service.’”
Sherif Emil, MD, FRCSC, is a professor of Pediatric Surgery at McGill University. He is the drector of the Division of Pediatric General and Thoracic Surgery at the Montreal Children's Hospital. He is also associate chair for Education in the Department of Pediatric Surgery at McGill. He sits on the board of Mercy Ships Canada.
Follow dispatches from the Africa Mercy
Sherif has embarked on his third mission with Mercy Ships, running from March 11-31, 2018, in Cameroon. Dr. Étienne St-Louis, one of his residents, will be joining him for the last 10 days of this mission.
Follow the Royal College on Facebook to read their live dispatches from the ship!
10 facts about Mercy Ships: a “unique model of global health”
- Mercy Ships is the vision of founder Don Stephens, who wanted to provide medical care to the world’s poorest by way of a “floating hospital.” It was founded in 1978.
- There is one ship (Africa Mercy) that travels the Western coast of Africa. Work on a second ship, the Global Mercy (working title), is underway. It is expected to be complete in 2019 and to travel the Eastern coast of the continent.
- The Africa Mercy spends 10 months docked in one harbour before moving on. Mercy Ships tries to revisit the same countries every 3-4 years, enabling staff on board to provide follow-up care or second-stage surgeries for patients they’ve been tracking.
- During the Ebola crisis, the Africa Mercy docked in Madagascar for two years.
- Services for patients are free and paid for through donations and fundraising. Staff on the ship pay for their own room and board. They come from all over the world.
- Missions range from a few weeks to several months or even years. Surgeons generally stay 2-4 weeks at a time, though some will stay for 1-2 months; the chief medical officer has been on the ship for close to 30 years!
- Africa Mercy has been in Cameroon since August 2017; the ship’s next stop is Guinea. A forward-operating team is already there, doing a detailed needs-assessment to determine what their visit to Guinea will focus on and where to do their patient screening.
- A large outreach effort is deployed to find patients whom staff can reasonably assist; for example, they decline patients who come in with kidney stones or certain types of cancer that cannot be treated on the ship. Some onsite screening will also occur.
- Patients who pass the screening are brought in to the port city where they will stay in what’s called a “Hope Center” - a residential centre that is built in every city that the ship docks in. This centre is where patients stay before and after surgery.
- Mercy Ships stresses the importance of working with local surgeons and reaching out to the community. The team has many capacity-building efforts, including health infrastructure projects, and training and workshops. They also hire a lot of locals.
Learn more on the Mercy Ships website.