Senegal 2.0

March 13 passed a couple weeks ago.
That might not mean much to most people--other than it's vaguely the time of year COVID started to be a real and present danger. 
To anyone who was on the ship on that day two years ago, however, it's quite a momentous date. 

March 13, 2020 was the day all crew were called into the International Lounge on the AFM and told, "We aren't doing any more surgery in Senegal. International travel is becoming increasingly challenging; flights are getting cancelled; borders are being closed. Our surgeons can't get here. Our anesthesiologists can't get here. We're going to send our patients home, and if you want to go home too, start making plans to do so."

We knew very little about the virus at the time, but we knew that anything that transmissible would wreak havoc on a tightly-packed ship like ours. We had enough trouble with GI bugs and colds already. 

That meeting ended with a promise: "We don't know when, but we will come back and complete the surgeries we have promised." We shared that promise with each post-op patient as we sent them on their way, bags bulging with nutritional supplements and dressing supplies. We shared it with each pre-op patient when we had to share the news - 'I'm sorry, your surgery is cancelled.' We shared it with each Day Crew who joined us in our bubble, sleeping on a mattress on the floor, until there was no more need for translators and we said our goodbyes. 

We are back. 

And boy are we facing some challenges. Fighting this infuriatingly contagious disease at every corner. 

But we are here. And we are fulfilling that promise.

Let me give you the Cole's Notes on what the last couple months have entailed.

January

The year started in a complete whirlwind. As with so many parts of the world, after months of relative security and fairly lax precautions, Omicron hit and it hit with a vengeance. Within days of two separate, isolated cases cropping up, both related to travel, we found almost 15% of our crew were testing positive. Another 40% ended up quarantined as they were high-risk close contacts. It was a nightmarish couple of weeks, and the tiny handful of medical staff we had on board at the time (myself included) were run ragged trying to stay on top of contact tracing, testing, and checking in on our positive cases. Just about anyone who wasn't in quarantine was spending all day every day supporting the crew who were; delivering meals, doing laundry, and turning over vacated quarantine cabins for the next poor soul. Quarantined crew in critical safety positions could leave their cabin for essential work wearing N95s and yellow, 'stay-away-from-me!' safety vests. When we ourselves ended up in quarantine, we kept working remotely to support the others, because...well, there really wasn't any other option. 

My Manager and I on a 'rapid-test-ALL-THE-CREW' day.

We were so close to our departure for Senegal, and we had to be COVID free by that date. 

In the midst of all that, I somehow managed to cram, write, and pass 2 exams! So, there's that. I'm now the proud holder of a Professional Diploma in Tropical Nursing from the London School of Hygiene & Tropical Medicine. Bring me your tapeworms, your amoebas, your plasmodia falciparum that I may diagnose thee!

As our ship-wide quarantine bubble drew to a close and the sail approached, we just crawled out of one spin-cycle of stress and into a different one. The hospital had to be ready for patients in 1 month. We scrambled to do everything we could to make it ready, then had to put a pin in that to cushion, cling-wrap, and strap everything down to get it safely across the sea. 

The chaotic month ended with the respite of a 4 day sail. 

A prayer walk was held on our last night in Granadilla.

Impromptu sunset jam session during the sail

Worship on the bow - always a highlight.

We were pretty excited.

Arrival Day!!

February

Days of endless tying-down and securing was followed by days of untying, unstrapping, and scrubbing and scrubbing and scrubbing. New nurses began pouring in, and within a few days our hospital staff had grown tenfold. The insurmountable task of turning overflow cargo storage into a functioning hospital began to seem attainable, and inch by inch, ward by ward, our Deck 3 space was transformed. 

Endless scrubbing...

To get from this...

And this...

To this!!

Literally as the ship was pulling up to the dock, our ground-based team was also arriving to set out palates, tarps, and roll out our dockside tents. It quickly went from a big, dusty, empty concrete pad, to a bustling hub for covid testing, patient selection, admissions and outpatients, as well as our transportation and supply staging area!

A couple of days before our first patients arrived, we had one last chance for all the non-hospital crew to see what the hospital is supposed to look like. It was quite a change from the cargo storage and contractor break rooms they were used to seeing for the last 2 years.

Some of the academy kids learned how to take a blood sample...from an orange.

One vial of orange juice, all ready to deliver to the lab!

And some got a ride in the CT scan!

Another pretty cool thing happened in those weeks of start up: we had four generations of General Surgery Team Leaders on the ship! Myself and my 3 predecessors! Two of them are now over on our sister ship, the Global Mercy, working to get the hospital up and running over there, and one of them was here with us as a ward nurse for a few weeks. 

(L-R) Tammy (pre-2015), Jane (2015-2016), Brittany (2017-2020) and me (2022-?)

Let me tell ya--I'm very grateful to have had all this wisdom and experience surrounding me during this time. 

Start up is always a slog, but it went by like a flash. And just like that, we were ready to open. Patients were already being screened on the dock. Senegal 2.0 was a go!

All crew on the dock after the mock hospital evacuation drill - the last key event before we can open.

March

Our first few patients embarked and surgery began almost exactly 2 years after we last sailed away. 

We started out the field service running Women's Health surgery (which includes obstetric fistulas and other gynecological surgery), as well as Maxillo-facial. As no one else was available to fill the role, I ended up stepping in as the Women's Health team lead for the first month. 

It was challenging, to say the least. Not only were ~95% of our nurses brand new to the AFM hospital, they also had to learn their way around caring for fistula patients; not really something you're exposed to in a typical high-income country's healthcare system. And although I have worked with fistula patients a number of times on the ship, it had been over 5 years and I certainly wouldn't call myself an expert. 

For anyone who isn't familiar with obstetric fistula, this website explains it well, but the short of it is: it's an injury acquired during childbirth that causes incontinence. Repairing this damage is tough, it has a relatively low success rate, and the women who live with this condition are often hardened by years of isolation. We work just as hard in this specialty to make our patients feel loved and whole emotionally as we do to heal them physically. 

Dance parties - a quintessential element of post-op care. In more ways than one!

Morning rounds with one of our women's health surgeons, Dr. Liz.

March is nearly through, and we are into our last week of women's health surgery. I'm starting to shift my brain into gear for the general surgery program which starts soon, and getting ready for many hernias, lumps, bumps, and goiters. 

If you're the praying kind, please hold up our fistula patients - they are all survivors of trauma, and some still face a difficult road of recovery. Pray too that we continue to be able to catch any COVID risk before it causes harm, and that we are able to continue to do surgery safely. 

Thank you all for your ongoing support and prayers.

From Senegal, 

À la prochaine,

-D