Goiter Screening

In early February we had our annual Goiter Screening.  Dozens of patients presented on screening day to be evaluated by the surgeon.  Some of these patients we have been following closely in our goiter clinic since way back in September.  These are patients that had abnormal thyroid levels.  We monitor them on a monthly basis to try and normalize these levels prior to surgery.  It’s always very satisfying to get them in tip top shape by the time the surgeon arrives.  It’s a fun process as well because these are patients that we have a sustained relationship with.  When we finally get to share their surgery date with them it feels like celebrating with a friend.

Pediatric Surgery

Check out this short two minute video of a 5-month old patient we were able to help in Madagascar last year.  Dr. Emil was on board again just a couple of weeks ago and it was so wonderful to have him back.  He operated on another case similar to the one in the video.  This is an exciting place to live and work!

Plastics Scheduling

The interdisciplinary team challenged with the task of scheduling all the plastics patients for 7 weeks of surgery.  They balance so many aspects like length of recovery, acuity, local vs. upcountry (based on the current and projected HOPE center capacity), skills of the ward and OR teams, rehab needs, and more.

Welcoming patients from up north

At the start of the new year we started our second block of plastic surgeries.  During this second block we bring in all the plastics patients that we have screened from our field screenings up north.  The screening lasts two full days and we process around 100 patients for about 7 weeks of surgeries.  They are busy days.

Here are some photos of our team welcoming patients to the ship after their long journey.

New Screening Tent

A couple of weeks ago our team moved tents on the dock and now we are in a slightly larger space that is completely our own!  Ria and the day crew did an incredible job organizing it and making it feel like a welcoming place for our patients.  After we meet patients in the field, the Screening Tent is where we do our secondary assessments and hold our surgeon screenings.

Screening Trip Photos – Benin

Photos by Ryan Cardoza.

On the road just south of Dassa, Benin

On the road just south of Dassa, Benin.

Near Dassa, Benin.

Near Dassa, Benin.

Shooting some hoops during a fuel stop in Bembèrèké, Benin.

Shooting some hoops during a fuel stop in Bembèrèké, Benin.


Gettin' that admin work done.

Gettin’ that admin work done.

My scheduling table in Bembèrèké

My scheduling table in Bembèrèké.

Team brief before our screening in Bembèrèké.

Team brief before our screening in Bembèrèké.

Deciding on the setup for our screening in Parakou.

Deciding on the setup for our screening in Parakou.


Field Screening Trip #1

(Note: this is a delayed post for security and other reasons)

On Sunday, 23 October a team from the Africa Mercy will head to the north of Benin for the first of two field screening trips.  The team consists of 4 members of the Screening Team, the Field Security officer, 3 additional security members, 4 translators, 1 member of the government, and a film crew.

Three, invitation only field screenings will take place during this trip:

Kandi – 25 October

Bembèrèké – 27 October

Parakou – 29 October

As I mentioned in a previous newsletter, these field screenings are the second part of the field screening process for the Benin field service.  We will be assessing and pre-selecting patients at each of the screenings that have already been registered during the month of September by the Referral Day Crew.  We look forward to this next step in the process and to the opportunity to invite many patients to the ship for Surgeon Screenings.

The team plans to return to the Africa Mercy on Sunday, 30 October.

We are grateful for the privilege of going on this trip and for the support and encouragement from so many you.  Updates will follow.

map of FS trip 1

The Surgical Imperative

This video here ties into an article i posted here, which is a huge reason why I feel like it is such a privilege to work with Mercy Ships.  We are working to correct the unmet need that is experienced by 5 billion people worldwide.  We are doing this one patient at a time through direct medical services, trying to sustainably impact health systems through our Medical Capacity Building programs, and trying to transform entire nations by helping them develop their National Surgical Plans.

Spurred on by Connection

This is a copy and paste of an entry that I posted on the Mercy Ships intranet site:

In the Madagascar 2015/2016 Field Service, 85% of the patients that we encountered during our 11 field screenings had problems that are not captured within the surgical scope of practice on the ship.  This is a significant statistic because it represents thousands of patients to whom we have had to say, “No”.

Most people that understand the screening process within Mercy Ships get this.  We’ve been given several wonderful opportunities over the years to share this difficult part of our jobs –  from programs reporting time to community gatherings.  Our closest confidants know how much this part of the job eats away at our spirits.  We caution our applicants about this fundamental aspect when they apply for a position on the team.

For me, one of the most beautiful parts of the Mercy Ships community is how incredibly it supports our team throughout this difficult task.  Extra portions of grace are extended to our team especially in our busiest of seasons.  We truly do feel loved and supported.  With this post, I wish to express our sincerest gratitude and appreciation to you all.

We are in the midst of one of the busiest prep and planning periods that we will do for the upcoming field service.  It seems as if a constant stream of numbers run through my tired brain.  How many patients for this specialty?  How many surgical slots do we save for patients from the interior? We can gain an increase in surgeries here but how does that affect rehab?  Or the wound care team? Or outpatients?   How do we adjust for “no shows” and patients that ultimately will not be surgical candidates?

For our surgeon screenings we always bring in extra patients as a buffer in case some simply do not show up for their appointment, are sick or have a medical problem that delays their surgery, or are ultimately not a surgical candidate according to our scope of practice and the skills of the surgical team.  We do our very best to calculate this as precisely as possible but inevitably we end up with an excess of patients and therefore must triage them, something most medical people are unfortunately all too familiar with.

This evening as I went over some numbers on how many neglected clubfoot patients we would bring in to screen in September, I paused at a thought that I surprisingly have never had before:


I am knowingly bringing in more patients than we can help.


I am planning on saying “No” to a certain number of patients during every screening.


In this particular case, it was just a mere 3 extra patients that I would bring in for this buffer for “no shows” and “no candidates”.  For most surgeon screenings it is usually 10-15.   Is that not such a dismal thought?  Planning to give bad news?

My shoulders slumped and my face fell into my hands as that thought registered with me. I find it difficult to find a silver lining that comes with delivering bad news.  It is simply no fun and each “no” weighs heavily on me.  But that doesn’t mean I still don’t view this job – this work we do as an organization – as the greatest privilege I have ever had.  Because for me, it truly is.  We have the privilege of walking with others through this harrowing process of life and experiencing the vast spectrum of the human experience.  The pain, joy, sorrow, laughter, anxiety, freedom, and adventure.  These dynamic emotions and experiences remind me that we are all connected.

That deep connection that we all share ultimately makes me want to work harder.  I want to strive to improve our procedures and processes in order that they reflect the patient’s best interest.  I want to pursue clinical excellence so that our medical assessments result in fewer patients being canceled for surgery and therefore fewer OR tables empty.  I want to stay up late at night dreaming of creative ways we can improve the efficiency and safety in how we reach out to find and select patients.

What a privilege this truly is.  Again, my sincerest thanks to the entire organization for the love and support that is poured out onto this team.


Nathan Claus, Screening Supervisor 


It’s time to play a little catch up.  I arrived back on our ship, the Africa Mercy, on July 29 after a little over three months in the US.  The ship spent most of June and July in Durban undergoing it’s annual maintenance phase.  We typically do this in either Durban or in the Canary Islands depending on the previous and the next country of service.  I arrived in Durban with just two days left in the city before we sailed on to Cape Town (post coming soon about that) and then on to Benin.  It was great to reconnect with friends and explore a new city.


Afros Chicken Shack on the promenade in Durban. Made for a delicious lunch.

Durban Sunrsie

A beautiful sunrise on deck 8 of the ship on my first morning back on board.


The pilot leaving our ship on our way out of Durban.

The ship departing Durban.

The ship departing Durban.


A mid sailing view from my cabin window.  That's right, after many years with Mercy Ships I now have a cabin with a window.  And even better, it's a single berth!

A mid sailing view from my cabin window. That’s right, after many years with Mercy Ships I now have a cabin with a window. And even better, it’s a single berth!