Saturday, January 30, 2016

That time I bored you to death rambling on about global surgery...azafady!

For my first post of 2016, I thought I’d dive head first into a topic that has weighed heavily on my heart since starting my work with Mercy Ships – surgery and its effect on Global Health. I’ll start by saying that this is a huge, deep subject which I will only touch the surface of so I understand if I lose some of you along the way. I will not be offended at all but I urge you to keep reading as it’s something I believe will help you understand Mercy Ships better and make you love this organization as much as I do :)

As most of you know, Mercy Ships primary focus is surgery and the Africa Mercy is a surgical focused hospital ship. Half of our hospital is operating rooms and the rest is made up of wards meant to care for patients pre and post-operatively. This means we can only treat about 10 or so types of diseases (which effect a huge portion of the population, but I’ll get to that later!). I’ve heard many who question our focus, myself included. Why limit ourselves to such a specific target when people are dying every day of all kinds of other diseases? This especially comes up in our screening process where hundreds of sick and injured people might show up to be turned away because they don’t fit our surgical scope. As hard as it is to see suffering and not be able to help, I’ve had to come to terms with two reasons why it must be this way.

Number 1: One of the core values of Mercy Ships is “to be people of excellence in all we say and do”. One way we live this out is that our leadership and assessment teams have chosen to focus on a few things and do them REALLY well. By choosing a small amount of diseases to treat, our surgeons can excel in those specific techniques and our hospital can ensure that each patient gets the best care possible. Basically, the easiest way I can explain it is that you have to choose between doing a little good for a lot of people or doing a lot of good for fewer people…but don’t get me wrong, it’s still a lot of people (we have yet to run out of patients that need what we can provide!).

Number 2: A focus on surgery can change a country in bigger ways than just the people who receive treatment. Over the past five months, I’ve heard at least 3-4 presentations about how surgery will be the key to the future of global health. Now, I understand we might be slightly biased because surgery is the focus of our organization ;) However, the rest of the world is starting to agree with us! It all started last year when the Lancet, the leading medical journal in the UK, published a group of articles called the Commission on Global Surgery. It was a huge study with huge results, basically summarized by this video:

See, surgery really is important! Dr. Mark Shrime, a surgeon from Harvard School of Medicine who comes to serve on Mercy Ships several times a year, wrote an article about this for the New York Times a few months ago. He also gave a presentation on it during his last visit here and that became one of the reasons I feel so strongly about this subject today. The whole article can be found here: I highly encourage you to read it. It’s not very long and he hits on a few really important ideas way better than I can. Here’s a couple of my favorite quotes:

“Despite the fact that nearly one-third of human disease is amenable to surgery, it remains overlooked in much of the world…To put this in perspective, H.I.V., tuberculosis and malaria — which have captured the global conversation — currently make up less than one-tenth of the global disease burden, combined.” 
“Moreover, reliable surgical infrastructure strengthens entire health systems. It is not enough to prevent maternal deaths during childbirth if a health care system cannot care for the children after birth. It is not enough to treat tuberculosis successfully if the patient then dies from a perforated appendix. Surgical scale-up is not and has never been envisioned to exclude other global health priorities — surgery is necessary to meet all global health priorities.” 
“For developing nations, it (surgery) is an economic issue. For the world, it is a moral issue, a question of equity. Surgery has been called the “neglected stepchild of global public health.” To achieve the recently approved global development goals, world leaders must explicitly develop systems to bring access to safe, affordable and timely surgery to those who need it.”

Do you want to know what the best part is? Mercy Ships has been doing this for almost 40 years and is pioneering the way to meet these global goals! Even better, we have an entire department committed to training and building up the capacity of the healthcare in the countries we visit so we can leave a lasting impact that reaches beyond the people who receive surgery in our hospital. As much as I love working in our hospital and caring for each patient who comes through our doors, I realize that this is only a small part of the mission of Mercy Ships. We are only in each country for a few months and can only treat a small portion of the population; but when we train surgeons, nurses and anesthesiologists or repair broken and abandoned operating rooms (just a few of the many projects our ‘off-ships’ team is working on) we are leaving things that will continue to make a difference for years to come.

All this can be summarized by one of my favorite quotes from our Chief Medical Officer, Dr. Gary Parker, “We cannot change the whole world, but we can change the whole world for one person”.
There is so much need in the world and it’s easy to get discouraged by all that we cannot help, but when I look at each patient we get the privilege to care for or the surgeons who are learning new ways to help their own people, I see that it’s worth it to change the world for that person!

Finally, you might be wondering why I’m bringing this up right now (besides the fact that I’ve been meaning to write about this for months). Well, so sorry (or azafady as they say here in Madagascar), but that reason will have to wait for next time – and it’s a really exciting reason so check back soon!!