Millions of lives in some of the world’s poorest countries have been radically transformed by Mercy Ships” free surgical and medical care. Geoff Garfield visited the hospital ship Africa Mercy in Madagascar to see the work of the volunteers who pay for the privilege of being on board

Everyone has the right to a seat at the “table of the human race”. If they are excluded because they don’t look the same or can’t speak, that is “catastrophic”.

The words are those of Dr Gary Parker, a surgeon who has given the past three decades to the global charity Mercy Ships, serving some of the most underprivileged people in the world: those who can suffer for years because they do not have access to safe, timely, affordable surgery.

The Californian was a senior registrar in the North Wales Oral and Maxillofacial Surgical Unit in the UK before joining Mercy Ships” which operates the world’s largest civilian hospital ship in 1986. “For me personally and us as a ship, I see it as planters of seeds of hope throughout some of the poorest regions of our world,” Parker says.

On board operations include repairing deformities caused by facial tumours, cleft lip and cleft palate, obstetric fistulas, paediatric orthopaedic surgery, plastic reconstructive surgery and ophthalmic surgery, such as correcting cataracts.

Since Mercy Ships was founded by American Don Stephens in 1978, 2.5 million people have benefited directly from its free medical care.

The charity’s 1980-built vessel, Africa Mercy, was converted from the 16,572-gt Danish ferry Dronning Ingrid.

The lifeline of hope that Mercy Ships provides will grow immeasurably stronger in 2018 when a newbuilding from China’s Tianjin Xingang shipyard is delivered, custom-built for the Texas-based organisation.
It is an expensive business: Africa Mercy costs tens of millions of dollars a year to operate, including surgical specialties, training, after-care and vessel maintenance. The challenge ahead is completing fundraising for the new ship and finding the 600 or so extra crew ” surgeons, dentists, nurses, catering personnel, administrators and translators, as well as officers and deck hands.

Mercy Ships’ 16 national offices around the world play a key role in raising money and sourcing volunteers who often sacrifice personal careers and salaries, while paying towards their board and lodgings.

It is hoped a big financial contribution will flow from a fundraising venture, Cargo Day on 19 October (see page 15). Shipbrokers, charterers, owners, traders and port agents can participate in the event organised in conjunction with broking house Barry Rogliano Salles, which assisted in placing the newbuilding order.

The new ship is set to be deployed in West Africa, while Africa Mercy will serve East Africa, including Mozambique, Madagascar and Tanzania. TW+ visited Africa Mercy in Madagascar, where it completed 18 months of field service recently before moving to Durban in South Africa for maintenance and on to Benin, West Africa, for its current tour of duty.

Africa Mercy is immaculately maintained and equipped, with five operating theatres. It even has a Starbucks, with ingredients supplied free by the American coffeehouse.

But volunteers do not get cruiseship luxury. A privileged few have family cabins (many volunteers live on board with their spouses and children) but for most it is shared occupancy, where the best start to the day is simply not having to queue for the shower.

Dr Gary, as he is referred to with great affection by his colleagues, says: “I think one of the greatest enemies to overcoming poverty and suffering is hopelessness, a feeling it will never change – “There is nothing we can do’.”

For hope to be believable, it needs to be “experienced in the present”, says Parker, referring to friends who have tried to encourage people that “tomorrow can be a better day, we can work and get schools for your children, clean water and maybe a health clinic”.

“But the response is, “What in my life experience gives me any reason to believe you are telling me the truth?” says the 63-year-old chief medical officer of oral and maxillofacial surgical, who completed his surgical residency at the University of California, Los Angeles.

“Then someone goes back to their village after having their cleft lip repaired, and suddenly hope becomes tangible. That plants seeds of real hope in people. I am convinced that one of the keys to overcoming poverty is offering people true hope, that we can actually work together and see suffering decrease.

“We don’t have to wait for the higher-ups and powers that be, we can do a lot ourselves. Just a little group of people who get together on a big steel boat and combine all of our efforts. It does work.”

Parker acknowledges that in private practice he could have surrounded himself with material wealth instead of living half his life on a ship and sacrificing the comforts other surgeons take for granted.

“You have to consciously decide you are not going to accumulate as much money, as big a house or as posh a car. It reminds me of the Tearfund motto all those years ago – “To live more simply that others can simply live’. That pretty much sums it up.”

The huge gulf that exists between medical care in much of Africa and the developed economies of the West was demonstrated clearly when Wesley, the son of Parker and his wife Susan, cut his arm playing soccer.

It became infected and led to a severe case of sepsis. Wesley was admitted to Africa Mercy’s hospital, but did not respond to antibiotics, causing concern because the condition could have led to the flesh-eating disease necrotising fasciitis.

If he had been living in Tamatave town, where the ship was berthed in Madagascar, without access to medical facilities, it might have been necessary to amputate the arm to save his life, says Susan, who points to a patient in Liberia who cut herself and ended up losing her lips when sepsis and necrotising fasciitis set in (Gary Parker rebuilt her lips).

“When it happens to your own kid it really comes home ” like, “Wow, we are so privileged”,” she says.

California-born, Seattle-raised Susan joined Mercy Ships in her twenties for six months – service, but 29 years later is still there. She met Gary within a week of arriving, and five years later they married.

Wesley is 21 and off to college after studying up to senior level in the MS Academy, a fully fledged onboard school for the children of crew. Daughter Carys has been studying at Whitworth, a Christian liberal arts college in Washington state. Carys, whom Susan describes as very altruistic, plans to become a counsellor: “She says: “I am going to be a doctor of the heart and help people with their inward tumours”.” Wesley is thinking about becoming a physiotherapist.

Susan says of her husband: “He knows every day he goes down to that operating room he will see a life change. He is very aware that he has been given a gift.

“Maxillofacial surgeons are very well paid but he said, “If there are enough to cover the needs of the US, if the NHS [the UK’s National Health Service] have enough, why am I going to vie for business when I can come here and be the only one in the nation?”
“Sometimes maybe the results aren’t as good as a Beverly Hills plastic surgeon doing cosmetic surgery, because when you are a train wreck it is hard to make you beautiful.

“But with a woman who may never have hope of being married, when he makes a new nose, it may not be the best because he had to make it out of a flap from her neck, but it is enough to get her married. And that is what she cares about: to have children, have acceptance, to be able to survive.”

Having raised a family on board Mercy Ships vessels, Susan sometimes feels she has missed out. “When I had children and no nursery to decorate and my children slept in the bathroom, I thought, “Is this the deal for me?” But when I feel ungrateful I go down to the [hospital] ward, stop at a few beds and then I feel happy with my life. I have water and when I flick a switch, the electricity comes on. I am blessed.”

The life-changing work is summed up by her husband: “For clefts [lip and/or palate] with the very young ones it is the difference between starving to death and living. You can’t breast-feed properly when your palate is missing. You can’t create the suction to get the milk. The mother tries her best, but we get these really malnourished children.

“Often these kids can’t go to school because it is too painful to be teased, be outcast or be criticised by well-meaning teachers who don’t understand that if you have a cleft palate, you can’t say the consonant sounds.”

The same day Parker allowed TW+ to witness a cleft lip operation, he also saw a man with a large facial tumour. “They die of slow suffocation, as the tumour pushes their tongue back into their throat, and because they can’t get a four-hour operation to get the tumour out – safe, timely, affordable surgery.”

If they don’t die of suffocation, it can be starvation. “It is slow and it is hideous,” says the surgeon. “I shouldn’t be saying these words, but it is better to have something that kills you quickly than kills you slowly ” but that is the reality for a large number of people.”

Asians have the highest incidence of clefts and Africans the lowest, but Madagascar’s genetics are predominantly Asian despite its location, 1,700km off the coast of southeast Africa. “Some place on earth, every 10 minutes a child is born with a cleft lip and/or palate, so from a public health point of view it is one of the greatest needs,” says Parker.

In parts of West Africa, mothers of children with such conditions are expected to take their child to a traditional healer and put them in a box, to be buried alive to destroy the evil spirits.

“Parents we have met have had to literally plead to keep their child from being buried,” says Parker. “With some traditional aspects of African culture the second-worst form of punishment is execution, but the worst is being evicted from your village. When you have to flee your village to keep your child alive, it is really dramatic.

“Some of these families are very courageous, coming to have their children repaired and going back to their villages to say: “We don’t have to destroy our children; look, here is our child”.

“It takes a lot of courage to do that because you are standing against very strong authority figures. The witch doctor and sometimes the queen mother and chief are all promoting these traditions which have been around for thousands of years.”

In Madagascar alone there are an estimated 50,000 women with obstetric fistulas, a medical condition in which a hole develops after difficult or failed childbirth. It leads to urine and faeces leaking through the vagina, and women are often rejected by their husbands.

Once healed and convalesced, the women are provided with colourful dresses and hats and take part in a moving ceremony of dancing and singing before returning to their villages and hopefully a better life.

“You live and work with incredible people. It is mind-blowing.” Words repeated time and again by volunteers on Africa Mercy, among them hospital director Kirstie Randall.

The former intensive care nurse from Exeter in southwest England has been working for Mercy Ships, first as a nurse and later ward supervisor, since 2003. She returned home at one stage, but realised her place was on the ship.

“When you have been part of helping people who can’t access healthcare, you want to keep doing it,” she says. “My job is all about planning.”
She oversees the hospital with its five operating rooms, wards and dental clinic.

During the service in Madagascar, 14 nurses were trained at the fistular clinic and “they are probably some of the best nurses in the country“, adds Randall. She says the orthopaedic programme focuses especially on children, partly because the results are better, including the Ponseti plaster cast method of treating club foot.

“Here [Madagascar] we have set up a clinic and trained people to do it locally. An international organisation, Miraclefeet, will carry on supporting that in the future.“
All Mercy Ships patients are given a package with a bar of soap, toothbrush and small mirror so they can see the transformation in their appearance after their operation. After a couple of days children of two or three are “on their way, but for teenagers it takes a month of just looking, and then the light starts to come onâ“, says Parker.

He remembers a 75-year-old woman who had lived all her life with a cleft lip. “She was so excited because “I can go to the market and I won’t be a witch or I won’t be the woman with the crooked lip “I am just myself.”

Dr Gary wears colourful African fabric trousers in the hospital to put patients at ease. “I have a shirt that matches, but if I wear them together, people fall over,“ he quips, before reflecting: “I know we can’t change the whole world, but we can change the whole world for one person, and then the next one, and then the next one. Part of being human is that we don’t give up.”

PLUS POINT 1
Many surgeons return to Mercy Ships year after year to volunteer their services, but Gary Parker’s 30-year devotion to the cause acts as a beacon. ” love the guy,“ says Africa Mercy’s managing director, Robin MacAlpine. “He’s humble, very, very real, a servant of nature. Humility is misunderstood in this world. It is a very positive thing, and that is what you see in Gary.”

Gary’s wife, Susan, did a masters degree in international studies and is part of the Africa Mercy team that teaches the crew how to learn about cultures. “What we know is medicine. What we don’t know is how people think, and it is important to realise we are guests in people’s houses. I am passionate about helping our crew to be culturally sensitive,“ she says.

PLUS POINT 2
Maritime costs for running Africa Mercy total about $5m a year, with a further $3m for support services such as vehicles and food. But that is only a fraction of the total: the various medical programmes cost around $22m a year, including roughly $20m of donated services and materials.
Volunteers contribute towards their own living costs, via baseline payments of $700 per month, often assisted by churches and families. Food is a big overhead. Three substantial meals a day are too good an opportunity for some of the locally employed workers to miss. It is understood they are paid only a few dollars a day, but that is in line with local pay.

View the article here

by Geoff Garfield, London

Published in TW+

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