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Monday, February 16, 2015

WHO Checklist / Lifeboat Training

Here is an article from our Medical Capacity Building Manager, Krissy Close about some recent training she has been managing.

If you want to see me get passionate about something, ask me about the Checklist. If you've had surgery in the last decade you may recall being asked several times on the day of surgery questions like what is your name, what are you here for today, and do you have any allergies.  

When I was asked these questions a few years ago before shoulder surgery, I wondered to myself "Shouldn't you know this? You're operating on me!" - but now I understand they do know, they are just following the "Checklist". 

The WHO Safe Surgery Saves Lives Surgical Safety Checklist (aka. the Checklist) is a simple tool that helps the surgical team to improve safety in surgery and has been proven to decrease operating room mortality by nearly 50%, as well as significantly decrease surgical complications and infections.  It doesn't require fancy equipment or expensive drugs; meaning it can have as large of an impact in Dallas or Minneapolis as it does in Bejing or Nairobi or Toamasina.  The only piece of the Checklist that actually costs anything is the use of a pulse oximeter; so for this we have teamed up with Lifebox, an organization dedicated to ensuring every operating room in the world has this vital tool, to offer pulse oximeters where needed.
Step 1 - Learn about the checklist
You might be thinking, "Well that sounds great and simple, just teach people how to use it!" - if only it was that easy.  Behavior change is hard; Just because we know we should floss our teeth every day doesn't mean we actually do it.  Just because we know we should use a checklist before surgery doesn't mean we actually do it.  
Step 2 - Modify for the environment and team requirements
The Mercy Ships Medical Capacity Building program has been working to try and figure out what it takes to successfully implement the Checklist in the local hospitals where we are serving.  Over the last two months several Crew Members have been working alongside the surgical teams at CHU Toamasina to develop a practical, modified Checklist, tailored to the needs and requirements of the hospital, and practicing it's use through simulations and practical application in the operating room. 
Step 3 - Practice use in simulations
This week we welcome Dr. Ed Fitzgerald, a general surgeon and Lifebox representative, to offer Lifebox training in Toamasina, Brickaville, Moramanga, and Antananarivo. The team is then heading across the country to Mahajanga next week for checklist and Lifebox training in two hospitals there.   It's our hope that through this simple checklist that we could see transformation of surgical care in this country, and in the world.  
Step 4 - Use in the OR
It's exciting work to be a part of, thank you for your prayers for safe travels and a positive reception by all the Malagasy healthcare professionals we have the honor of serving in this way!

Read more about the WHO Checklist at http://www.who.int/patientsafety/safesurgery/en

Monday, February 09, 2015

Where Are Our Patients Coming From

I've always thought of Madagascar as a little island off the coast of the Southern tip of Africa - but when you are here you discover how big this country is.  It takes around 8 hours just to travel by road to the capital city.
Comparison of size to UK!
Over the last few months Mercy Ships has been carrying out screenings around the country.  In December a team headed up to the capital city of Antananarivo where they saw many patients in need.  Some of them began arriving here at the end of December.  They met many patients with powerful stories, including a VVF patient who walked for 5 days and then rode a taxi-brousse for 2 days to reach the screening site with the hope that Mercy Ships could help.  Another who's father summed up best what a new lip would mean for his 11 year old son who faces constant ridicule because of his cleft lip: "My family doesn't speak to me or my son.  No one wants to have anything to do with us.  If you can do this surgery for us, it will change our lives."
This was followed by another screening by the Mercy Vision Eye team.  We are discovering that the Malagasy have very good eyes so the team have had to go further afield to find suitable candidates for surgery.
Our surgical screening continued on in Toliara which is the capital of the large Atsimo-Andrefana region, one of the poorest in the country.  The region has a total estimated population of 1,018,500 (2004).  Then this past week in Mahajanga, in the North West to the Boeny region partnering with MAF (Mission Aviation Fellowship) to help fly them there.

This has made travelling for patients a little harder than previous countries so through the work of crew members, funds have been secured from various local businesses and cell phone fundraisers to pay for all their travel to and from the ship, whether by road or air.
Here is a map to show where they are coming from (this was calculated before the Toliara and Mahajanga screenings) :

Sunday, February 01, 2015

Hope Centre - More Transformation Photo's

 Here are more photo's from our Hope Centre Renovation.  The building is now open and housing all our patients that are recovering from surgeries.
Before / After
Before / After
Before / After