By Melissa Chin, PGY-3, Western University
Roman Gusztak just finished his anesthesia training at the University of Saskatchewan and will be pursuing pediatric anesthesia and pediatric critical care fellowships in the States. In his third year he participated in an elective to Sierra Leone with Mercy Ships.
Can you tell us a bit about what Mercy Ships is, and how you came to be involved?
Mercy Ships is a charitable organization that was established in 1978. Their main ship, the Africa Mercy, is a 152m floating hospital visiting the West coast of Africa and spends about 10 months a year docked in a different country. Unpaid volunteers representing around 35-40 countries help run the ship at almost every level, including the captain! On board, there are 6 ORs, 74 ward beds, 4 NICU/PICU beds, X-Ray, CT, and full lab services.
I first heard about Mercy Ships through a lecture by a staff anesthetist, Dr. G. Morris. The idea of a hospital ship that would provide free surgical care to Western Africans sounded incredible! Then in my third year, I had the opportunity to accompany Dr. H. Reimer from the University of Manitoba to serve on the Africa Mercy, which was docked in Freetown, the capital of Sierra Leone.
What was different about working on Mercy Ships?
Well, I suppose it was the ideal scenario. We were inside Africa, but it was like working in a North American hospital with constant electricity, excellent OR and post-op conditions, and a wide array of drugs. However, there was also a lot to get used to. The anesthesia equipment was donated from all over the world, so we needed to adapt in lots of little ways. Sometimes the drugs that were available had to be rationed, and we had to be more considerate in our choices, improvising occasionally.
Further, back home you may have to deal with equipment difficulties/malfunctions once a month. On the ship, it occurred every two or three days, but that just kept us on our feet.
There was a more personal side too; I got to see my patients face to face all the time as we lived on the ship together. The wards were beside the operating rooms and this allowed me to get to know the children really well in the post-op period. It was at times difficult to communicate with the patients, but some things, like free candy, requires no verbal communication, just a big smile. Most patients stayed for days or weeks after their surgery and we became good friends. It was a balance and lifestyle that I very much appreciated.
Further, I needed to use a translator to communicate with most of the patients. At times 2, or even 3, translators we required when speaking to a patient from a rural village. I’m not sure how accurate the pre-op assessments were in these individuals, but it was definitely a memorable experience, usually with lots of laughing and hand gestures.
What did you get to do when you where there?
The whole medical experience was phenomenal! I did a lot of pediatric orthopedics…There were also advanced and severe cases of benign tumors, cleft lips/palates, clubfoot, bowed legs, burns, nomas (a gangrenous facial disease), etc that you would never get in the Western world.
Each night, we would usually have about 3-5 inpatients to see pre-op. With the children, most of them had likely never had a full physical exam since they were born and then all of a sudden, we were assessing them for the first time for anesthesia. It was a little scary especially when they had so many deformities and we were relying mostly on our physical exam skills (instead of all the imaging that we are used to in Canada) to rule things in and out.
What was it like living on Africa Mercy?
For the most part, it was like living in an air-conditioned three star hotel with the poverty that is typical of African capitals right outside your door. You definitely feel privileged to live in these conditions when people a few yards away have so much less. The people on the ship form an entire community of volunteers that support the ship and hospital, and that means a school for the children of long-term families, a shop, a hairdressing salon, an internet cafe, a weight room and gym, and a Starbucks with one dollar double shot lattes. Starbucks actually donates free coffee for the volunteers on the ship and we were only charged for specialty coffees.
How were the sleeping arrangements on such a packed ship?
Cozy – Bedrooms were often shared with 2 others, each with a single washroom. This was much better than some of the nurses being 8 in a room and housed in bunk beds!
What was it like visiting Sierra Leone? What did you get to do?
SL was amazing! The people were soo friendly and approachable! The kids were also a lot of fun to play with. Surprisingly they didn’t ask you for money when you went around the city. All they wanted to do was hold your hand. I also felt very safe when I was away from the ship and even went for excursions all by myself through the markets. For the month that I was there, no one from the ship had been robbed or assaulted. The people treated the workers from the Africa Mercy very well.
My schedule was incredibly busy, and if I’m being honest, I wish I had organized myself to get off-ship a bit more. The first activity I got to do was go running through the city, and it was incredibly eyeopening. The veracity of the poverty was striking, yet I never felt unsafe. The privileges on the ship just seemed that much more apparent after having spent time running in the city slums.
What did this experience mean to you?
For me, Mercy Ships represents one of the reasons why I felt compelled to go into medicine. It is summarized well in a quote from a Missionary Surgeon, Dr. Paul Brandt, who imparted this profound truth of his medical career while completing reconstructive surgery to lepers in India:
“The most precious possession any human being has is his spirit-his will to live, his sense of dignity, his personality. Though technically we may be concerned with tendons, bones and nerve endings, we must never lose sight of the person we are treating.” I was able to participate in surgeries that physically transformed patients from many devastating anomalies. However, even more powerful than this was seeing a person’s hope and identity restored through a combination of the surgical procedure and also showering them with love and compassion. I was amazed how far a small amount love could go to make a patient realize their self-worth. It’s something I will never forget. We are truly blessed in Canada with amazing health care resources and training, and I’m looking forward to participating in more overseas opportunities in the future.