A medico-maritime life for me

If it looks like a ship and it sails like a ship and makes sounds like a ship…it’s probably a floating hospital.  At least if it’s the one that belongs to the charity Mercy Ships, currently docked in the Port of Conakry in Guinea, West Africa.

Photo 1_ship

Bon jour! (The port approach is a lot wetter than starboard entrance)

The MV Africa Mercy is the largest charitable hospital ship in the world, providing free surgical services (primarily facial reconstruction, benign tumor excision, cataract removal and child orthopaedics) to the African countries Mercy Ships visits on a rotating basis.

Photo 2_map

Pre-Very Useful Bridge

A repurposed Danish passenger ferry, she took to the seas in 2007 after a very useful bridge built between coasts en route, put the 16,500-ton vessel on the job line.

About 400 long-term staff, 200 local day workers and a rotating crew of volunteers – surgeons, anaesthesiologists, nurses, radiographers, technicians, engineers, administrators, cleaners, cooks, carers, families, officers and of course a captain – are paid up members of this unique medico-maritime community.

(Actually staff pay their own way on board – although the volunteer-staffed Starbucks is generously subsidized by the mermaid herself.*)

This week, by gracious invitation, Lifebox is finding our sea legs too!

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We’ve joined the faculty of the Anaesthesia Care Team (ACT), led by Mercy Ships international board member Dr Keith Thomson (who, alongside his team, delivered our pulse oximeters to Togo last summer), for a three-day training course at Donka Hospital – one of two national facilities, both in Conakry, and the largest hospital in Guinea.

We’re ready to join about 60 anaesthesia providers and midwives for two days of lectures, workshops, quizzes and dancing (possibly we’re not 100% ready for the dancing? But you should be!) in essential anaesthesia and midwifery techniques, followed by a day of the WHO Surgical Safety Checklist and pulse oximetry.

Photo 4_ACTs

And we’re very excited for the donation of French-language pulse oximeters to outfit the six hospitals represented at the course, donated with the proceeds from Dr Keith’s recent half marathon adventures!

The Africa Mercy usually spends ten months in each country it visits, wending along the West African coast and ducking back to the Canary Islands in between for repairs.  This is her first trip to Guinea but the charity’s third, following two prior visits from the MV Anastasis (nee Victoria).  She arrived in August, with six operating rooms and nearly 80 patient beds to house the patients eligible for surgery.  Many thousands have shown up for screening, and the lists will stay full until the ship pulls out of port this spring.

Guinea is a low-resource country, but isn’t resource-poor: as the world’s top exporter of bauxite, a key component of aluminium, it sends mini-mountain ranges out of the port regularly.

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The islands are lush and the sea is fish-blue.

Photo 7_lush Guinea

But the post-colonial legacy and ongoing conflict has been disastrous for most of the 10 million people who live here now, heightened by refugees and tensions from neighbours including  Sierra Leone and Mali.  Guinea most recently ranked 178 out of 187 on the UN’s Human Development Index, with just 1.6 mean years of school for adults and a life expectancy of 54.5 years.

There are only four medical anaesthetists in the entire country, and no standardized programme for anaesthesia training whatsoever.  The doctors here have studied in France, in Moscow; the technicians have learned on the job. There isn’t a single working pulse oximeter in the main operating block in Donka.

The unmet surgical need is vast.

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An operating room at Donka Hospital

Over the next few weeks we’ll be sharing stories from the ship, from the dedicated crew, from the fabulous ACT team – and from the patients.  They are still queuing up in the hot sun on the dock for screening, often alone and from far up country, in the hope of a life-changing operation they’ll not find anywhere else, from a ship that – with the best will in the world – was built to sail away to another port in need.

Sail away

 

Women in the workplace

Over breakfast at the SAFE course/Lifebox training in Rwanda a few weeks ago – bread, boiled eggs, thick black coffee and milky African tea –

Breakfast

It’s always nice to see what people have for breakfast

– a male guest at the Dereva Hotel was heard to inquire:

“Tell me, why it is that women dominate anaesthesia?”

Was that a glint in his eye or not?  Either way, he had a point – to a point.

There’s limited evidence of female domination in the higher echelons of the healthcare profession, i.e. medical anaesthesia.  The road through medical school to specialization is male-dominated, and although there are two female residents in the current first year cohort of the anaesthesia programme at CHUK no women have graduated since it launched in 2006.

Female residents_CHUK

Professor Angela Enright with the two female trainees at the CHUK anaesthesia programme

But the anaesthesia technician profession is different.

All techs graduate from the same three-year programme at the Kigali Health Institute (KHI), which was set up in direct response to the crisis-point shortage of healthcare workers in Rwanda.

They are trained in the practicalities of anaesthesia, and only the essentials of physiology necessary for the job at hand. KHI has trained about 30 anaesthesia technicians a year since the programme began in 1996, and there are now about 160 working in Rwanda.  Although the medical anaesthesia programme is no longer nascent, techs far outstrip the number of medical graduates at present.

Resus_SAFE

Practicing patient resuscitation at the SAFE course

So their responsibilities are vast. Techs look after the operating rooms; they do emergency resuscitation (trauma, shock, cardiac arrest).  In rural areas, they can end up with cases even more complicated than a medical anaesthetist at a teaching hospital would be faced with, alone.

And because applicants must have completed a science qualification to be eligible for the programme, with the majority coming from nursing, demographics mean that a high proportion of techs are women.

Resus 2_SAFE

“I had to work all hours!” explained Jeanette Kayitesi, an anaesthesia tech in Kigali, reminiscing about her first job in a small city hospital where she was the only anaesthesia technician.  “They always came to get me.  They came to get me in the middle of the night.  They came to get me on maternity leave…”

Domination?  Maybe not.  But it’s certainly a dramatic change from the position of women in Rwanda a generation ago.

Women at SAFE

La DOMINATION at the SAFE course

“In the past, they didn’t like it when a married woman kept working,” explained Mediatrice Usabye, an education director from southern Rwanda, who was in Rwamagana for a conference.

“People saw a woman as someone to marry, to raise children; if a family had a boy and a girl, the boy was the one who went to school.

In the classroom_SAFE

“But after the genocide the government realized there was a disparity between male/female education, and a gender imbalance in all domains.  Now things are changing.  They’re working to close the gap.  Women have paid maternity leave (one month in the private sector; three months in the public sector).”

Today, the rector of KHI is a woman.

KHI_rector

Dr Chantal Kabagabo, Rector of the Kigali Health Institute

So is the anaesthesia department head at the National University of Rwanda.

Christine

So is the Minister of Health.

MOH

Dr Agnes Binagwaho, Minister of Health

That doesn’t change the fact that the reason women appear to ‘dominate’ in anaesthesia, sir, is partly because they are encouraged to train as nurses, not doctors.

“You may ask me why that is,” said Mediatrice, imposingly.  “It’s because so many books are written in Rwanda, especially in primary studies…they show pictures.  Pictures of women as nurses and teachers.”

CHUK_OR

Anaesthesia providers pose outside the operating theatres at CHUK

But Rwandan women are writing their own stories long after they finish primary school.  Take Jeanette.  She recently finished her Masters in Public Health (MPH), and wouldn’t be satisfied, she explained, if she didn’t keep learning and working.  She likes her job as an anaesthesia tech because her day is never the same twice.

She also has five children, aged between 12 and three.

At first her husband nagged when she carried on working after they were married, after their children were born.  Why did she have to take further studies?  Why couldn’t she stay home with the kids?

And now?

The magnificent Jeanette

“He’s so proud. Now when we’re out, I hear him on the other side of the room, telling strangers about my job.  Well, he says, my wife…

Happy International Women’s Day!