Thursday, 4 December 2014

The Road Ahead is Long

A couple of days ago I went to the local hospital to work with one of the nurses who is in a training program with the ship. Here are the facts. The surgical ward where she works has 50 patient beds. There are only four nurses on the work schedule. They work 24 hour shifts as the only nurse, being helped by some nursing or medical students for some part of the day. Just let those facts sit in your mind for more than a minute.

24 hours shifts.

Minimum of 50 patients.

Limited equipment and by that I mean, they have one manual blood pressure cuff, one thermometer and one stethoscope.

There is no oxygen, no suction, no running water and no supplies on hand.

Needless to say, the hospital is run very differently from one in the western world. There are so many differences here that I don’t even know where to begin. For a start, every morning after the doctor has done his ward round and prescribed the treatment for the day, the nurse will write out a script for the patient’s relative to take to the hospital pharmacy. It might look like this: IV cannula x1, IV tubing x1, Normal Saline 500mL x2, Ceftriaxone IV x1g, 10mL syringe x1, gauze x1 pack, tape x45cm, betadine solution x1 bottle. All these things are packed into a green and white striped plastic bag and neatly tied and carefully transported, glass ampoules and all, back to the ward for the nurse to begin the treatment when she has time. The prescription paper now not only has a list of the contents in the bag but also the price of each item bought by the family. Each precious item has a price and I heard it said on the doctor’s round, if the patient has no money to pay for treatment then they can leave and someone who has money can have the bed. That’s how it goes.

The patients in the ward all have a story. One was picking fruit from his fruit tree and thieves came, thinking he had a lot of money because of all the fruit he was picking and attacked him with a machete. He had been sliced open all over his face, head, back of the neck and flanks. He had been stitched back together in the hospital’s emergency department and actually looked surprisingly good, although in pain.
Another patient had tried to commit suicide by stabbing himself in his gut, which had led to internal damage but not serious enough to cause death. One young girl had had an abortion but needed further curettage for pieces still left inside. One boy had somehow gotten a meat hook stuck in his neck. Several patients had fallen out of fruit trees breaking one or more bones in their legs or spine. One man had fractured his spine so severely they are calling it a miracle he is alive, yet he’s stuck in bed with a spinal collar on because they don’t know how to fix him. His spinal cord is being pinched and a slight slip could mean paralysis not just to his body but to his lungs, causing death. Other patients have been hit by cars or have had motorbike accidents leaving them with head injuries or fractures. Some have had hernia repairs or their appendix removed.

While we were walking around with the doctors, there was one lady sitting on the side of her bed, gasping for air and crying out. She was clearly in distress but no one seemed to bat an eye. When we asked what the problem was, they simply said “Asthma”. Someone from the family had gone to the pharmacy to get some medication. In the mean time there was nothing for us to do. There’s no oxygen standing by, no crash cart with emergency drugs, no resuscitation equipment to rely on.

I’ve seen these same circumstances now in several countries in Africa, limited to no supplies, a huge lack of running water, power, soap, suction and oxygen. The absolute basics are missing.

A few weeks ago two of our Mercy Ships crew members gave a presentation with a lot of statistics about many of the countries that the ship has been to in recent years and others close by that we have not yet visited. Seeing these numbers and graphs with terrible statistics for overall health and healthcare systems in these countries, somehow tightened my resolve to be here. The presentation continued to tell us how Mercy Ships planned to partner with the local hospitals and work alongside them, teaching and educating, running classes and mentoring. The idea is to work ourselves out of a job. Although I’d heard it before and knew what programs Mercy Ships ran, at hearing it presented again, I felt my heart jump up and down and God whisper to me, This is why you are here. I want to see lasting change. I want to see so much change that the local hospitals will be well equipped, not just with the basics like power and running water, but with supplies and the knowledge to use them. I want to see the staff educated, supported and empowered to make changes to improve their working conditions and the outcomes of their patients.

The nurses that I have worked with from the local hospital are well educated. They are creative and make the most of the supplies they have, inventing ways of doing things with their limited stock that we would never dream of. They are hard working, uncomplaining and joyful despite their circumstances.

The road ahead is long, but we have to start somewhere. People are always asking me, How long will you stay on the ship? Well, how long will it be until we can change the healthcare statistics of the nation? Of the continent of Africa? Even though I see the road stretching ahead far into the distance, there is hope. We have already begun the journey.


  1. Thanks for this excellent nursing insight. I hope you don't mind if I share with my nursing friends here in Clearwater, Florida, USA

  2. Love this. Nursing in Africa is sooooo much different than in the US. And I do hope and pray that the healthcare systems across Africa will improve. Thank you for your work!



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