Out Like A Lamb...

Christmas and New Years have come and gone like a whirlwind, and 2019 has come to an end.

It has been a bit of a wild one for me, let me run down some of my...

Thank you, Original Broadway Cast of Hamilton.

Highlights

• Ringing in 2019 on a night shift, then celebrating with family and friends in my apartment - using up as much food as possible before...
• Joining the ship in Guinea, meeting old friends and making new ones
• Watching in awe (and in tears) as kids got to see for the first time in their lives
• Deciding to return for a full field service
• Watching the slow, painful, but eventually joyous healing process of one particular ortho patient
• Playing SO MANY games of Deception in midships
• A wonderful summer at home with gardening, beach dates, work, yard sales, and brunch
• Crossing an international border and great lake by tiny car ferry
• Catching up with friends from abroad (and explaining to the TSA agents that I was meeting friends from Africa...but they're actually from New Zealand, but they live in the UK...)
• Returning to the ship in Senegal
• Rehearsing and performing acapella with the Key of Sea
• Transforming empty, packed-up wards into bustling centers of care & healing
• Being given a Senegalese name by a plastics patient ("Mariam Seck")
• Sharing a traditional Senegalese meal of Thieboudienne at our day crew's home
• Getting to document our patients' journeys as a ward photographer

One of my fav photos

• Living around baobab trees - enjoying their fruit, their beauty, their canopies!
• Cucumber Nativity (ask me later)
• Watching Modou (a particular plastics patient) dance

1 second a day from my time in Senegal!

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Now, I did promise a bit of Q&A about screening back in December, and I was able to quickly chat with Screening Nurse Maddy.

The Q&A's of Yes's & No's

Q: How does screening work here in Senegal?

A: The Senegal Ministry of Health decided to run their own pre-screening, selecting about 1000 potential candidates in each of the 13 regions. This resulted in over 13,000 patients for us to see, which we did over the course of about a week in each region. About half of the screening team goes upcountry for these screenings, while the rest of us work here on the dock. Only about 1 in 10 patients we screen will get into the dockside screening. The vast majority are no's - but in many cases it's a simple matter of 'we don't have the right kind of doctor to fix the problem you have.' Those are easier no's. The hard ones are when we could help, but we've simply run out of space.

   Once they get an appointment for dockside screening, we'll give transport money to help them get to Dakar (if needed), and a lot of them will stay at the HOPE Center. They're seen one more time on the dock to do a more thorough nursing assessment, and sometimes to start treating any co-morbidities (like high blood pressure) that might make surgery more risky. Sometimes we have to delay their surgery to follow up on something, like a patient recently who had a large wound on their leg. Goiter patients need several months of medication before surgery, and monitor them every week.
   Eventually, when the surgeon for that specialty arrives, they'll see every potential patient on their list, and decide exactly what surgery will be done (if possible), and when. Then they're passed on from us to the Admissions team.

Q: Have you ever gone out of your way to make space for a particular patient?

A: Yes. Sometimes we know we only have 10 slots for a certain specialty on a certain screening day, and I'll try to hold out for the patients who could benefit the most. I remember seeing Mohammed in line and thinking, "That's a good one for Dr. Gary, we've got to save a space for him!"

 Mohammed before (above) and after (below) surgery to remove a facial tumor.

Q: Do you ever refer patients you can't help to a local hospital?

A: Yes, but it depends. Although we try to make our information campaigns clear that we treat mostly chronic injuries & conditions, we still have patients arrive at screening with what is clearly an acute illness. Something that should be treated within days. Local hospitals are better equipped to treat these types of problems than we are on the ship, and in a more timely fashion (our surgery dates are often months after the screening has taken place). If we find a minor problem, we may recommend the person seek help from a doctor when they can. If it is a major, potentially life-threatening problem, we can and have arranged transport to a hospital and transfer care to a local physician.

A little peek into screening in Senegal with Christelle, a Ghanaian screening nurse.

If you're interested in the nitty-gritty stats of screening, plus numbers from all our programs so far in Senegal, check this out (click to embiggen - or try this link).

That's all for now. Sorry for such a long radio silence!
À la prochaine.