Hope...Does Not (in this case) Float.

As promised, may I present the HOPE (Hospital Out-Patient Extension) Centre:

Not too long ago, it looked like this:

The HOPE Centre is an integral part of Mercy Ships' work in every country they visit. While the surgical interventions provided on the ship are tremendously beneficial, they are a small part of a very big puzzle. Mercy Ships is a well oiled machine, and has figured out (over the past 37 years or so) how to best address the very large void in the healthcare of developing nations.

If we could sail the ship around, plopping down fully equipped, staffed, and funded western hospitals in every country we visit, that would be really awesome.

But, unfortunately, it's also just not feasible.

Mercy Ships' model works because it allows experienced professionals to give as much or as little time as they're able. Said professionals also bring enough money to keep the hospital running. It also brings almost all of the infrastructure needed to run a hospital. It's self-contained, and pretty much self-sustaining. It isn't ideal. It can't resolve the entire healthcare crisis in Africa. It can't reach land-locked nations. And it can't be in every place it's needed at once. But it is a start. And there's more going on than meets the eye.

Because there's hope.

Capacity Building

So. The wise powers-that-be recognized that, while they could simply perform a few thousand surgeries and move on to the next country, there is so much more that can be done during each field service. As such, an essential part of the process is capacity building: training, mentoring, renovating, equipping, and engaging the local community; giving them the tools to continue the work once the ship has to leave. 

The HOPE Centre plays two roles. It is (as its acronym implies) an extension of the ship, while it is here. But it is also a piece of a bigger puzzle that leaves the country a little bit stronger than it was before. 

When Mercy Ships selects a country to visit, it sends a team months in advance to begin preparing (in fact, we just heard last night from the advance team that is already preparing for the next field service in Benin)! This team makes all the neccesary arrangements for the ship to function when it arrives. This includes four very important things that aren't available on the ship:

• A dental clinic
• An optometry clinic
• An admissions & outpatient centre
• Lots and LOTS of extra beds.

The first three things, they can be put in a tent, or just about any old building with power. The last one is a toughie, but it's essential. Because every effort is made to reach the whole country, many of our patients live several DAYS travel from the ship. They also, however, require follow-up care, sometimes for weeks or months after their surgery. The wards on the ship contain about 75 beds, not including the matresses under the beds for caregivers to sleep on. 

If that was all the beds available, and we had to wait till our patients were 100% before sending them home, the number of people we could help would be SEVERELY restricted. 

And this is where the HOPE Centre comes in. 

The advance team finds a building (often a disused hospital, in abysmal disrepair), and renovates it to make a safe, comfortable place for patients to live, near the ship, until they are well enough to travel home.

Here's a few more before & after shots of the HOPE Centre here in Tamatave:

Believe me, it's not as serene as it looks. There are kids scurring around in every nook and cranny, and hanging off you every chance they get.

The HOPE Centre here in Madagascar is located right next door to Hopital Be, a local hospital that was also in a bit of a sorry state when the ship arrived last year:

But a solid partnership between the hospital and the ship has been established. They've received some renovations of their own:

The staff of Hopital Be are also heavily involved in other elements of the capacity building programs, such as the surgical training courses, the W.H.O. sanctioned OR safety program, as well as nurse and physician mentorships.

The obstetric fistula program has also hugely benefited from the HOPE Centre, as it also contains a secondary clinic for fistula patients. Unlike most patients, who just need an outpatient check-up every so often for a while, the fistula patients require some nursing care for several weeks until their catheters can be removed. The clinic at the HOPE Centre frees up beds on the surgical ward here on the ship within a few days, so instead of only being able to treat 15 or 20 patients in a month, we can treat around 60. That means 600 total for the field service.

My fabulous cabinmate doin her thing
over at the Obstetric Fistula (OBF) Clinic

Still just the tip of the iceberg, considering about 2000 women in Madagascar develop a fistula each year.

This is why, thanks to a partnership with the Freedom From Fistula Foundation and Hopital Be, after the ship leaves, fistula surgeries will continue in Tamatave, as well as in other hospitals throughout the country. We are mentoring Malagasy nurses on my ward and in the clinic, so that they are confident and capable of continuing this post-operative care in the clinic at the OBF clinic.

Local nurses learning the ropes.

There's a lot more that goes on in regards to capacity building that I'm not super familiar with, I've just shared the parts I've seen in action. You can learn a bit more HERE.

Azafady (remember that one?) for a really long post, but I hope it was interesting!