Saturday, November 12, 2016

The Great Patient Search

I realized recently that I don't remember ever writing about how we find our patients. This process is called "Screening". It's a pretty interesting process that highlights the flexibility of Mercy Ships and the way the organization has grown over the years.

Mercy Ships is well known for something we call "Mass Screening Days". It may even be something you think of when picture Mercy Ships in West Africa...long lines of tired people standing in the sun or rain all day for a chance to be seen by a doctor and possibly receive a free surgery. Maybe it looked something like this:

Up until a few years ago, this is how screening worked. The ship would arrive in a new country after advertising for several months about what kind of problems we can treat. We would rent out a big facility (like a stadium or empty building) and have hundreds of volunteers from the crew spend 12-14 hours seeing patients all day long, giving them dates for possible surgery and saying no to thousands of others who did not fit the criteria. Generally, the entire surgical schedule for a country would be filled in one day. While it was an exciting day that many looked forward to as "Mercy Ships Tradition", it was long and hard and not very efficient.

Then came Madagascar. This country was a completely different animal. A huge island with a poor transportation system and a port located hundreds of kilometers from the capital city - the only city that most of the population can easily get to. How do we find patients in a place like this? One giant screening day was just not an option.
In comes this idea of a Screening Team. The idea had already been in the works for a while because people had begun to realize that there had to be a better way to do things than mass screenings. Unfortunately, in our world today, we have to start considering things like safety and spread of disease. Attracting thousands of desperate people to one public place creates many problems in itself. So why not send the Screening Team to the patients instead of having them come to us? This was trialed in small scale the first year Mercy Ships was in Madagascar and used almost completely to find patients for Madagascar 2. Last year, the team went to 13 sites all over the country, screened patients we could help and invited them to the ship for a specific date when they could potentially have surgery.

Screening Team - Madagascar 2015-16
While this process is still being tweaked, it seemed to work very well for that situation. Transportation was still an issue as it can take several days to travel to certain cities in Madagascar, but thanks to a partnership with MAF (Missions Aviation Fellowship), the team was able to fly to some of the far sites and even brought some patients back to the ship by plane as well! Once the patients came to the city where the ship was docked, they were given further examination and seen by a surgeon to confirm they were fit for surgery. The screening team is made up of nurses so they are not able to confirm until a surgeon sees each patient - but they do a pretty good since something like 95% (I don't have that exact figure) of patients brought to the ship were approved for surgery.

Screening Team after a MAF trip in Madagascar
I'd consider that a pretty successful system. In fact, it worked so well that they decided to keep a similar process for future field services with a few tweaks. For Benin this year, we have had a combination screening process. When the ship first arrived, we held 3 weeks of screening days in this city. While we are not located in the capital city, Cotonou is a large city and only 1 hour from the capital so a large portion of the population live nearby. For several months, Mercy Ships advertised about these screenings with a goal to fill about 50% of our surgical spots for the 10 months we will stay in Benin. This ended up having a huge turnout and thousands of potential patients were seen.

Cotonou Screening Center
 But what about the rest of the county? While Benin is much smaller than Madagascar, the rest of the country is more rural and not as accessible. When we agreed to come here, the government specifically requested that we do all we can to reach those in need in the north of the country farther from the capital. A new idea was formed. A group of Beninoise people were trained and sent out to different regions all over the country. Mercy Ships gave each of them an iPhone and created an app that can be used to take patient information and find out if the patient fits our criteria for surgery. These workers spent several weeks searching their region to find potential patients and sending the information back via internet to the Screening Team on the ship who approved or denied each patient to attend a local screening day in that region. Talk about Tele-medicine!

And now, the screening team has just returned from the first of 2 field screening trips to the north of Benin where several small screenings will be held specifically to see the patients found by these local screeners and give them a spot to come for surgery. Maybe it's just me, but that's a pretty awesome process! We're still waiting to find out how effective this method is, but if it works, there is the potential that it could be used in future countries, saving a lot of time and energy for the screening team and reducing the number of No's that must be said.

I even had a small part in the screening process this week! As Orthopedic Team Leader for the ward, I've had the opportunity to go along with our Orthopedic surgeon the past few days as he assessed about 100 patients with Orthopedic deformities to find which patients we could help. The screening team did a great job of finding many patients who will fit into our program. Although it was a long and full 3 days of seeing patients and organizing the schedule, it was very interesting to be a part of what goes on behind the scenes before our patients get admitted to the hospital.

Orthopedic patients waiting to be seen by surgeon during screening
Straight legs coming your way!
Working on the schedule after a long day of seeing patients.
Overall, finding our surgical patients is a huge blessing and challenge - and I am extremely thankful to have a Screening Team who can do this for us! They are often the first interaction a patient has with Mercy Ships and that's a big responsibility. Many patients leave happy with a surgery date but many others must be told "No". In fact, in Madagascar last year, the screening team had to turn away over 5000 patients. While we try to do all we can in each country, we have limited space, time and scope of practice that makes it impossible to say Yes to every patient we see. It's not an easy job and this team needs your prayers as they make hard, life-changing decisions each and every day!