Toliara

The second week in January we took a screening trip to the southwest city of Toliara and stayed almost a week to screen and select patients. At the end of three days of screening we selected a total of 86 patients.

We ended up staying a day longer than planned because at the end of our second day of screening we still had not given out all the appointments we saved for this region. Also, our contacts in the city urged us to stay as long as we could because they kept telling us that it takes time for news to travel and to reach the small villages. Often these remote villages are where the need is the greatest and so our team of eight was all happy to stay an extra day to receive more patients. We gave appointments to just 6 patients on that extra day but three of them were from a village over 300 km from Toliara and they had traveled more than two days to get to us.

A child with bilateral club feet who started the first round of casting this week with our rehab team.

A teenage girl with burn contractures to her left axilla.

A teenage girl with a bulging tumor extending from her left mandible.

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I’ve been organizing transportation for the last month or so for all the patients that we will select from Toliara and Mahajanga (another city we went to in January). This isn’t something we normally do for our patients because in the past it has never been a major issue. We’ve helped some patients on an as needed individual basis in other countries but Madagascar is uniquely a very large country. From north to south the distance is about the same as from Buffalo, New York to Jacksonville, Florida. However, our patients here don’t travel on 4 lane interstates or take 1-hour flights on jets. They cram into a “taxi brousse” and take winding and sometimes very bumpy two lanes roads to get from town to town. Our first bus journey happened that extra day we were in Toliara so it was very special for me to be there in person and see our patients climb on the buses I’ve organized (more spacious than the taxi brousse) and get to wish them a “bon voyage” to Tamatave. I saw them two days later on the dock as they came for their surgeon screening and diagnostics. All of them but one were scheduled for surgery.

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Approaching the landing strip in Toliara

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Sunset on the west coast

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our plane to Toliara

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The first group of patients from Toliara in front of their bus transport

Blood Donor

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One of the many unique and fun parts about living on a hospital ship is the fact that our crew is our hospital’s blood bank supply.  We have very limited space to bank blood so if a patient needs blood and you’re a donor then you get a call in your office or your cabin asking you to come down to the lab to donate blood.  My blood is some that they actually do bank before I leave each time because of my type.  This is a photo of me donating 400 ml of blood yesterday.

Last Two Months Recap

Tana screening team - 18 December 2014 - Antananarivo, Madagascar

Tana Screening Team – 18 December 2014 – Antananarivo, Madagascar

I arrived to the ship on 7 November. My first week back I got to be a part of screening patients Monday through Friday at our Toamasina Screening Center. This is the first field service in as long as my Mercy Ships history goes back that we have not had one day of a massive “main screening” when we first arrive in a country. The screening center was open for the entire month of November. Our team saw a huge influx of patients the first few days and then a good, steady amount for the remainder of the month. Having more than one day to see patients allowed us to give more time to each patient. We were able to better explain how we could help them. Even more, it allowed us to give a better explanation of why we could not help, instead of just a quick “sorry” and having to move on to the next patient.

Just over a week after arriving I was tasked with setting up, organizing, and running our screening in the capital city, Antananarivo (Tana, for short). I spent four weeks there working with the Ministry of Health, doctors from 5 different hospitals in the city, and partner NGO’s coming up with the best way to find and screen patients.  We ultimately settled on a registration system via the 5 local hospitals, which meant I spent a good amount of time training doctors at these hospitals about the Mercy Ships scope of practice.  I discovered I really liked that.  For me, it is always special to partner with others in our work and it was especially encouraging to me to see their eagerness and excitement in what we do.  We all have the common purpose of helping the Malagasy people.

We held an open registration for two days for any patients interesting in being treated by Mercy Ships. My colleague and I then reviewed all the registration forms and selected those that fell within our scope of practice.

The last week I was in the capital, a small team from the ship joined me and we saw in person all of the patients who were registered at the hospitals.  Those were two great days as we got to see all those weeks of prep work come together and patients standing in front of us. I think it all went really well and we found a total of 178 patients that will come to the ship to see a surgeon and likely get surgery.

Another project I have been tasked with is a Patient Transportation Project. We will screen for patients in two coastal cities this month – Toliara (southwest) and Mahajanga (northwest). From all of our conversations with our partners and with the government we have been told over and over again that patients will not be able to afford the travel cost to come to the ship in Toamasina. It’s our goal to reach those most in need so we have brainstormed several ways to reliably help our patients reach the ship for surgery. I’ve been partnering with the Ministry of Transportation and a transportation company to work out the many logistics needed for this. We will transport a total of about 400 people (200 patients + 200 caregivers) over the course of the next five months so the logistics involved have not been a breeze but I’ve found that I really like the challenge. I learned a lot doing this type of logistical work in Congo-Brazzaville a little over a year ago. It proved very frustrating yet also quite rewarding when the patients finally arrived to the ship after their long journeys.

Evening Stroll

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Today I did a training with about 20 doctors from 5 Hospitals in and around Antananarivo.  On Thursday and Friday these doctors will register patients who are interested in being treated by Mercy Ships.  This is all part of the unique method we have developed to screen for patients in a very large city hundreds of miles from where the ship is docked.  We of course discussed the specific scope of Mercy Ships and which type of patients we can treat but also went over in depth the whole registration system which has multiple detailed steps.  I feel like it was a success and I am eager to see how the Registration goes on Thursday and Friday.  Looking forward to hearing feedback from the doctors as well.

Later in the afternoon I headed out of my hotel to a store to buy some more credit for my mobile phone.  The short walk to run a simple errand turned into quite a long evening stroll.  I winded up and down the streets of Tana, through several neighborhoods, and finally ended up on the tallest hill overlooking the city.  It was a  beautiful view and it somehow feels like a perk of the job to get to experience stuff like this.

Scenes Around Tana

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One of the Hospitals in Tana where patients will register for a Mercy Ships screening

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Traveling around town from meeting to meeting in a vintage Citroen

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Coming home with the goods

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just outside the city center, a well-irrigated field.

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Children walk home from school in the afternoon sunlight

Hotel

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The hotel I stayed at this past week had a lot of character.  These stairs leading up to my room were my favorite part.

Antananarivo

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Boarding my flight to Tana

Tana from my hotel

Tana from my hotel

Yesterday I flew from Toamasina to Antananarivo (Tana) to begin work on preparing the screening we hope to have here in December.

Antananarivo is the capital city and about 500 km from where the ship is in Toamasina.  It is the largest city in Madagascar with an estimated population of at least 1.4 million people.  As in Congo-Brazzavile we have found ourselves in a similar situation where the ship is not docked in the capital city.  Yet we know there are patients here we can help and of course we want to find them.  So the screening team and the leadership on the ship have had several meetings last week to brainstorm and come up with ideas on how to screen in a city with an enormous population but without all of our resources close by.  We’ve come up with an idea and I am here in Tana to have meetings with the government and other partners to try and make this happen.  It’s exciting and there will be more news to share as details get worked out.

Return

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I arrived back to the Africa Mercy this past friday after a three day journey from Chicago.  It feels so good to be here again.

Last night I prepped for my first day back at work.  I had my backpack ready, my clothes laid out, and I turned in early for the big day.  And what a big day it was.  We screened a couple hundred patients today and my heart burst with excitement.  It was amazing to be back and meet patients that will soon have their lives transformed by surgery.  Many of them have had these ailments for years and this was their day of hope and anticipation.  I felt so honored to be a part of it.

Madagascar

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Changes are afoot yet again.  Madagascar is on the horizon.

I left the Africa Mercy just before Christmas last year and have settled in Chicago for the better part of 2014.  I’ve been working in a Pediatric Emergency Department.  I’ve become reacquianted with the midwest: the frigid winters and the balmy summers, but best of all with my dear friends and family who live here.  It has been a wonderful time full of exploration, challenge, laughter, learning, and immense growth.

However, for months now that scene from LOST has been playing  in my head.  You know, the one where Jack and Kate meet just beneath where all the planes are taking off at LAX.  With a frantic look in his eyes he laments, “We have to go back…….Kate, we have to go back!”  Ok, so it’s not that dramatic for me, but there is no denying that the urge to return has surfaced.

So I’ve resigned from my job and will be working again with Mercy Ships.  It is an honor to join the Screening Team and the ship in Toamasina (Tamatave), Madagascar.  We’ll be implementing some new screening methods which I am quite excited about.  Hopefully they will make the whole process more efficient, safer, and better for the potential patients.

I’ll be there for three months.  As was the case before, I will be a full-time volunteer responsible for covering all my expenses including flights to and from the ship and monthly crew fees.  If you are interested in supporting my work with Mercy Ships with a tax-deductable donation please visit the Donate page.  I am so grateful for your support.

I head out on Tuesday, 4 November and arrive to the ship on Friday.  Updates will soon follow.

It’s a pleasure sharing a work that is so dear to my heart with all of you.  Thank you for joining me in this.

Interior Screening

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Last Wednesday we returned from our Interior Screening Trip.  It was an incredible trip and a perfect way to end my time with Mercy Ships.

The following is a transcript of what I said about the trip during our Programs Reporting Time on the ship last Friday.

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Good morning and thank you for joining us today.   My name is Nate Claus and my role on-board is Screening Coordinator.  My job so far this field service has largely been centered around the interior screenings in Oyo, Ouesso, and Impfondo that we are here this morning to tell you about.  Before we really get in to all the details I’d like to invite Mirjam up to share some thoughts that many of us on the team had in regards to what we would share with you today.

(read by Mirjam)

We’ve been asking ourselves how we should measure the success of a patient screening trip.  Is it purely statistics?  Or surgery slots filled?

The numbers are important, but they don’t tell the whole story.  Every number has a name, and every name is a life, individuals with their own story to tell.  When we talk numbers, we must not forget about the one.

So rather than focusing on numbers we want to present to you the people for whom this whole trip was about.  We want you to be as excited as we are about the people whose lives have strategically intersected with ours over this past weeks.  People like Simon, who despite the large Neurofibroma on his face, couldn’t stop smiling after he received his patient card. Or Benjamine who sustained serious burns to both her arms and neck 6 years ago. Or Siara, born with a cleft lip and palate, she and her mom are living in Impfondo as refugees from the Central African Republic.  Or Chadley, Annie, Brunelle, Emanuel and Esperance.  People who now have the opportunity to have the surgery they never thought would happen, and ultimately dignity restored & hope renewed.

With the Oyo, Ouesso and Impfondo screenings complete and hundreds of kilometres travelled by car and plane, we are looking forward to receiving all these patients in Pointe Noire.

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(back to Nate)

I’d like to start by introducing the rest of the incredible team I had the pleasure of journeying into the interior with the past two weeks.  For some strange reason I was deemed suitable to be the leader of this pact and entrusted with the responsibility of organizing and heading up this trip but I could not have been even remotely successful for it not with the efforts of these people standing up here with me.  This was a team in every sense of the word and I never doubted once that this group could accomplish what we set out to do.  So my first of many thanks goes to each one of you.  Thank you.

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Let me introduce them.

Matt Tveite is programs security officer on the ship.  Matt was in charge of security for the screenings and transportation logistics.  He worked tirelessly to get our lassez passiers from the government so we could freely travel all the routes we needed to.  He was on duty 24/7 for the last two weeks and we knew he had our backs.

Steven is the 4th Engineer on the Africa Mercy.  His role during the trip was a part of Matt’s security team.  He was also our car mechanic, comic relief, and token cowboy.  And, after two weeks on the Congolese roads we can all say that he now is able to drive stick.

Krystal Remers is a ward admin assistant and on the trip was also part of Matt’s security team.  She was the gentle rose between the two thorns of the security team.  She was always willing to help with whatever needed to be done and was a great addition to the team.

Mirjam Plomp is a nurse in the screening team and was my right hand woman during the trip.  I was thinking back to September when she was a last minute addition to the assessment trip we took, asking to come along to learn the ropes.  Now, a few months later, she is all set to take over for me as screening coordinator come Monday.  She is well-prepared and I have no doubt she will do an incredible job.

Jasmin Biddell is a new addition to the screening team and was along as a screening nurse.  She brought her taste for good coffee, enthusiasm and adventurous spirit to the team.  Mirjam also wants me to say that she was the perfect replacement for her husband.

Missy Brown is Assistant OR supervisor and an expert Mercy Ship’s nurse.  She acted both as a screening nurse and the OR scheduler for the trip.  She was essentially our expert consult for all things surgical and she happened to turn the big four “O” on the trip this past Tuesday while we screened in Impfondo.

Keith Brinkman serves as Programs Administrator on the Africa Mercy and joined us for the last screening in Impfondo.  He is an expert gate person having stood his post at the gate for 5 total Mercy Ships screenings.  It was a pleasure to have his enthusiasm with us for the last portion of our trip.  I’m pretty sure he already has dibs on certain patients we saw during the screening as his “befriend a patient” so if you can’t find Keith around the ship look for him down in the wards.

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So, why do we screen in the interior?  If you’ve been around Mercy Ships for a little while, then you’ve probably heard more and more talk of forging into the interior to find our patients.  It goes without saying that a large portion of our patients will always come from the port city.  However, to truly reach the people of Congo, we must look further than the city we are docked in.  Beyond Pointe-Noire and Brazzaville there are Congolese people that desperately need the surgical services that we can provide.  Generalizations can be dangerous, but it is probably fair to say that most people living outside the main cities have little to no access to healthcare.  It either doesn’t exist, especially in the case of specialized surgical treatment, or they simply cannot afford what is available.  Consider a poor farmer in a small village with minimal income.  He has to decide whether he will spend his money on food, or his children’s education, or for travel expenses all the way to Pointe-Noire hoping for healthcare on a big white ship.  And all of this travel and expense is without any guarantee that he will even be selected for surgery.  That may not be a gamble he is willing or even able to make.  These are the very people we have come to serve.  Since they cannot reach us, we travelled across this country for 12 days looking for them.   It truly is an honor to serve these people and we are grateful for the opportunity to do so.

So the beginnings of the interior screening actually happened several months ago in September when five of us from the ship traveled to the screening sites on an assessment trip.  Our goals were to assess the sites for patient flow and security; establish contacts and build relationships with the Hospital Directors and our partners; rendezvous with selected orthopedic patients; determine transportation logistics for future selected patients; and to have trainings with representatives from the Ministry of Social Affairs.

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Screening Assessment Team in Ollombo, Congo

 

As I mentioned, we held trainings with representatives from the ministry of social affairs.  The purpose was so that they could help identify appropriate surgical candidates for us and direct them to the screenings.

Andrea and Sophie provide training in Oyo, Congo

Andrea and Sophie provide training in Oyo, Congo

Partners: For the last several months we have been working with Felbo, a Congolese NGO, to help us advertise for the screenings.  Of course a big partner in our work has been the Congolese government, who have been providing free transportation to and from the ship for the patients that we have selected.

So where did we screen?  Oyo, Ouesso and Impfondo

Oyo is a town straddling the plateau and cuvette regions. It is about a 450 kilometer drive from Brazzaville.  I never managed to find statistics on the size but Wikipedia tells me the neighboring city of Owando, which is a bit larger than Oyo, has a population of around 26,000. Ouesso is another almost 500 km drive further north from Oyo.  It is a town of around 20,000 people in the Sangha province.  The Sangha province has somewhere between 200,000 and 300,000 inhabitants.   Impfondo is almost directly East of Ouesso by a few hundred kilometers but it is only reachable by plane or river barge from Brazzaville.  Impfondo is also a city of around 20,000 people.

While I am talking geography I’ll just mention that it was very encouraging to us as we registered patients when we realized how far they came to get to the screenings.  Several came from distances over 300 kilometers away.  This was encouraging because the word had indeed gotten out about our screening plans.

How did we get there?  Getting to the places we needed to screen was a mission unto itself.  You may think I am kidding when I say this but transporting our vehicles on the train from Pointe-Noire to Brazzaville in time to drive to Oyo for our first screening ranks as one of the greatest accomplishments of my life.  Steven and Courtney, who worked for an entire day in Brazzaville this past Monday to get the vehicles back to us in Pointe-Noire probably know that I definitely am not kidding.  It was one of those experiences that I’ll remember forever, don’t ever want to repeat, and finally am able to laugh about….at least a little.

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To get up to Impfondo we had the great experience of getting to fly up to Impfondo on a Mission Aviation Fellowship 10-seater Cessna.

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Goals:

In my notes I have written “Find more patients!”  Our goal was as simple as that.

 During the ten month field service in Congo we aim to do approximately 1600 surgeries in Max Fax, Plastics, VVF, Ortho, and General specialties.  Six hundred spots have been reserved for patients outside of Pointe-Noire.  In November we had our screening Brazzaville which yielded almost all of the 300 patients we planned for from that city.  That left almost 300 open spots for the interior screening trip to fill.

 Statistics:  We promised numbers so I’ll move on to statistics now….

The totals are for all three sites combined.  554 total potential patients came to the screenings.  We scheduled 172 and had 291 spots available.  The breakdown by specialty is as follows:

Max Fax: 55 out of 129 spots available

Plastics: 18 out of 35 spots available.

General: 87 out of 87 spots available.  15 patients put on wait list.

Vesico Vaginal Fistula (VVF): 12 out of 40 spots available.

 

With that, I’m going to invite Missy up to share.

(Missy shares personal reflections, as the OR scheduler, getting to interact with every single patient that we selected to come to the ship for further screenings.)

 (Photo slide show)

Closing:

On behalf of the whole team, it has been an honor and a privilege to represent Mercy Ships as we searched for patients across Congo.  Thanks especially to Gerrit and Esther for entrusting us with this responsibility, and to Laura and Amy for keeping the screening team afloat while we were away.  Thank you to the entire crew for all of the prayers and encouraging notes we have received.  It was comforting to know that we had hundreds of people on the Africa Mercy and all over the world standing behind us.  It is a pleasure to serve the poor alongside you.

Nate Claus, 13 December 2013 // Pointe-Noire, Republic of Congo

End of the screening day in Ouesso, Congo

End of the screening day in Ouesso, Congo

Fun times at the president's ranch on our day off in Oyo
Fun times at the president’s ranch on our day off in Oyo

Oyo Hospital on screening day
Oyo Hospital on screening day