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Ship of hope

Cate Swannell
Med J Aust
Published online: 15 September 2014

There are many ways to volunteer your time and medical skills to help the world’s poorest people. Mercy Ships offers a unique experience for surgeons, anaesthetists, nurses and allied health professionals.

Dr Ann Marie McCallum doesn’t have to be a good sailor to volunteer on board the Africa Mercy, which is just as well.

“It’s a converted Danish ferry”, Dr McCallum tells the MJA. “Apparently she rolls around quite a lot on the open ocean.”

Like most of the staff and crew serving on board Africa Mercy, Dr McCallum joins the ship when it is already in port, safely berthed and secured.

The ship sails from its home port in the Canary Islands with a skeleton crew on board before being populated by doctors, nurses, allied health professionals, cooks, cleaners and sundry others working to improve the lives of some of Africa’s poorest populations.

Dr McCallum, an anaesthetist at Westmead Hospital in Sydney, has served three missions with Mercy Ships — 4 weeks in Sierra Leone, 6 weeks in Guinea, and 3 weeks in Congo.

She plans to go again in April of next year, this time to Benin, but that depends on the Ebolavirus outbreak currently raging in West Africa.

Africa Mercy was due to start its year-long Benin mission last month, but at the time of writing, she was still in the Canaries awaiting a decision about what was safest for the crew and hospital staff.

“On board a ship it’s quite a confined environment and that’s not what you want with Ebola”, Dr McCallum says. “When a Mercy Ship is in port, people also tend to flock to the ship, travelling long distances to come and see us — and that’s not ideal with Ebola either. You want people to stay where they are.

“So Africa Mercy is not equipped to deal with Ebola [or other infectious diseases]”, she says.

The main business of Mercy Ships is surgical, repairing facial deformities and injuries, birth fistulas, cataract removal and lens implants, orthopaedics and removal of tumours not usually seen in developed nations.

Africa Mercy is, according to Mercy Ships, the “world’s largest non-governmental hospital ship” and has five operating theatres and an 82-bed ward.

The hospital covers approximately 1200 square metres and is divided into quadrants containing supply/services, the operating theatres, recovery/intensive care and low-dependency wards.

Melissa Mason, Mercy Ships’ national communications manager, says it’s not uncommon for volunteers to serve multiple missions on board.

“Many say they enjoy the experience of living and working in a community environment of like-minded, supportive people who share the same goal of using their skills to help the forgotten poor and are drawn back to Mercy Ships for this reason”, she tells the MJA.

Dr McCallum agrees, saying that while Mercy Ships allows her to experience new places and people and challenges her professionally, it’s an environment that is controlled and familiar enough to make that experience both safe and rewarding.

“It’s certainly an adventure”, she says. “But, when we’re in theatre I know there is a secure power and oxygen supply and that our drugs come from a reputable supplier.”

That’s in stark contrast to other relief organisations that may take a limited supply of equipment in to isolated areas and then have to rely on what they can make do with, regardless of the circumstances.

Dr McCallum graduated from the University of New South Wales in 2002, started her anaesthetics training at Royal North Shore Hospital in Sydney in 2006 and became a specialist in January 2013 after spending some time training in Edinburgh.

Her first mission with Mercy Ships was in Sierra Leone, on her way to Edinburgh, in 2011.

Maxillofacial surgery was a major part of that mission.

“It was quite challenging from an anaesthetics point of view, because [patients with maxillofacial deformities] can be difficult in terms of finding airways”, she says.

It was heartening to see the huge difference even simple surgical repairs could make on people’s lives, she says.

“Having a facial disfigurement is seen as unlucky and people can be shunned and mocked because of it. A simple cleft lip can be repaired easily and to watch them wake up and ask for a mirror straight away and then see their beaming smile … it was amazing.

“It can make such a big difference to their employment prospects and their marriage prospects.”

One of the most debilitating and challenging conditions faced by the people of West Africa and the staff on board Africa Mercy is noma — an opportunistic infection starting in the mucous membranes of the mouth, causing ulceration, tissue degeneration and, at its worst, bone degradation and death in 80%–90% of cases.

It is associated with malnutrition, poor oral hygiene, poor water quality and compromised immune function.

“It’s not something we see outside the developing world”, Dr McCallum says. “Most of the cases occur in children under the age of 5 and it causes horrific scarring. The worst I’ve seen is where the face is half eaten away.

“It can take three or four surgeries to cover or repair the defects, but again, it can make such a huge difference to their lives — to be able to go outside without head coverings, or just a small scarf.”

Dr McCallum’s second mission, to Guinea, also involved general surgery and plastics, repairing untreated burn scars. Her work also involved training locals in anaesthetics.

“In these areas anaesthetics are not given by trained specialists”, she says. “Usually it’s nurses or lay people who have been given 3 to 6 months’ training of variable quality, with limited drugs — some of which we no longer use in the Western world — no professional development, no feedback and no ongoing education. So part of the mission is to give them as much training as we can.”

Her third mission, to Congo, saw her assisting in many obstetric fistula repairs, another relatively simple but life-changing surgery for the women of the region.

“Often when they first came on board, these women would be very nervous, very quiet, but they would watch the ones coming out of surgery very closely and see how happy they were”, Dr McCallum says.

When the women left the ship staff crew would hold a “dress ceremony” where each woman was given a new dress before they sang and danced their way off the ship and into new and immeasurably improved lives.

Although several of the countries Mercy Ships serves have unstable political situations, security is a priority for the organisation and in 36 years of operation there has never been a serious threat to the ship.

A Mercy Ship sails much less than most commercial vessels, with some 20 days a year at sea. Mercy Ships closely monitors multiple streams of information regarding risk areas and plans its routes carefully. It maintains best practices when sailing, and antipiracy protocols and equipment.

“While a Mercy Ship vessel is always prepared to cast off in an emergency situation, none has been required to do so in our 36-year history”, Melissa Mason says.

“Mercy Ships holds the security of its crew, which includes volunteers from some 30 to 40 nations, in highest priority.

“Our security protocol is developed from assessments conducted by our advance team as well as input from various embassies and government officials.

“Mercy Ships employs full-time security guards, supervised by our ship security officer. There are trained security personnel on duty 24/7.

“Mercy Ships does not serve in conflict areas, although it has served in post-conflict venues, such as Sierra Leone and Liberia, after the cessation of hostilities.”

Dr McCallum says she has never had a concern.

“I’ve never been scared”, she says. “In fact the people in all three places I’ve been have been so welcoming and happy to see us. It’s been a very happy experience.”

Mercy Ships has a unique business plan.

While the medical staff are all volunteers, all pay to be on board.

“We pay our own travel expenses to and from the ship”, Dr McCallum says. “And we also pay a monthly board and food amount as well. In effect we pay them to let us work for them. But it’s absolutely worth it, every time.”

A new Mercy Ship is currently under construction and planned for delivery in July 2017, and will be equipped and staffed for its first field service in 2018. The Atlantic Mercy will more than double the annual medical capacity of Mercy Ships.

For more information about Mercy Ships, visit http://www.mercyships.org.au.

To listen to the full interview with Dr McCallum, visit https://www.mja.com.au/multimedia/podcasts or download the podcast from iTunes.

  • Cate Swannell


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