Screening: the Good, the Bad and the Ugly

Roughly 1500 people lined up for the screening every day for the first week, many of whom were already outside when we arrived before dawn. Some had even spent the night.  

Desperation: that was the feeling lingering in the air. As I helped our screening team prepare the school grounds we were using as our screening center early on the first open day of screening in Benin, I learned a little more about the desperation a disparity in healthcare will create. I heard it in the shouts as the line outside the school argued and pushed, anxious to be seen, and I saw it as the Beninese police arrived to calm things down and organize a line. “Dear God,” I prayed, “please protect these people. May your peace wash over this place and still this crowd as you stilled the waters and the storm.” Thankfully Mercy Ships’ Security for the screening team had already accounted for needing police and a secure location. Nobody was injured while seeking care with us during the screening process. We were soon able to open the doors and slowly bring people in.

My first day at screening was filled with mixed emotions. I stood just inside the gate as we let prospective patients in and directed them to enter the line where they would be seen by a prescreening nurse who would determine whether they had a surgical issue within Mercy Ships’ scope of practice. Those who passed prescreening would then be directed inside the building where a more detailed health history and assessment would take place. As I smiled and greeted each patient I grew excited when I saw people we could help. Many orthopedic patients with crooked legs came through the line, including the most adorable little boy, who despite being shy came over and placed his hands in mine. I am really hoping to see this little one again on the ward, but with straight, strong legs. 

During the first day many patients passed the initial screening process and were given an appointment card for a surgeon screening during which the surgeon preforming the surgery can make the final decision whether a potential patient is a surgical candidate. The joy as these patients exited the compound radiated from them; however, for most in line, we are unable to help. In a country where there is only 0.1 physicians for every 1000 people it is not surprising that when a hospital ship comes into port people come from miles. Many of those who come do not have a health problem that can be helped via surgery. We saw patients with cerebral palsy, Downs Syndrome, strokes and so on. Many also come through the line with health problems outside our scope of practice. Most cancerous tumors are one example. Sadly, we do not have the capacity to provide chemotherapy/radiation and follow up for these patients. Removing these tumors in most cases only prolongs death and can cause additional pain. For these patients we offer palliative care assistance which consists of nursing care focused on patient comfort as well as spiritual care by hospital chaplaincy.

The other day I assisted at screening was at the end of the second week. I’m not going to sugar coat it. This was an extremely hard day for me. At this point in the screening process we had filled our orthopedic and general surgery spots. We only had space available for our plastics and maxillofacial (jaw and face) surgeries; however, we were overrun with ortho and general patients. This meant we were forced to turn away patients who had needs within our scope of practice simply because we did not have the capacity to meet their needs.

As I stood at the exit directing traffic, I was the last point of contact for the people we turned away. Most understood, but some questioned me as they left, showing me their problem as if hopping we might have misunderstood and can provide them with the care they needed after all. Saying I’m sorry, no was very difficult, but for me the hardest part was watching the ortho kids leave. I could see them coming from a distance and knew that we had been unable to accept them. It broke my heart, and the image of two of these little boys will stay in my head for a long time to come.

I realize that this is not the happiest blog post. It hurts to think about the pain others go through. It’s much happier to talk about the people we can help provide a happy ending for. Sometimes I wish that I could close my eyes to that side of the world and not feel the pain, but that isn’t the way God views the world. I was reminded later in the day by a dear friend that when we ask God to love like He loves, we must expect heart break because the consequences of a sinful world break His heart too. By allowing myself to really see people and feel a little of their pain I am able to better understand the heart of God, and am being molded closer to His image.

Heal my heart and make it clean

Open up my eyes to the things unseen

Show me how to love like You have loved me

Break my heart for what breaks Yours

Everything I am for Your kingdom’s cause

As I walk from earth into eternity

                                                                       Hillsong United - Hosanna
                               

        In the mist of heart break, however, I am reminded that the art of medicine is also individualistic. When I am with a patient all my focus is on that patient. We may not be able to heal an entire country, but we will change the lives of many individuals. I was reminded of this over the last few days as patients have come to the ship for their follow up surgical screenings, many of them hiding their deformity under a scarf because they are so used to being ostracized and looked down upon because of it, and I cannot wait until I can care for them and show them how much love the God who knitted them together has for His creation.  

In this the love of God was made manifest among us, that God sent his only son into the world, so that we might live through Him. In this is love, not that we have loved God but that he loved us and sent His son to be the propitiation for our sins. Beloved, if God so loved us, we also ought to love one another.                                                                                                

                                                                                                                             1 John 4:9-11

Prayer Points:

1.      The patients we turned away

2.      The surgeon screening process.

3.      The health of the patients leading up to surgery. That nothing would hinder, postpone, or cancel surgeries.

4.      For the hospital which opens September 11 and will perform its first surgery the next day.

5.      The spiritual protection for the Ship and all those aboard: patients, visitors, crew and day crew.

6.      For me. That God would continue to show me how to love those I’m serving and the strength to endure such a love.

Author's Note: While I am currently serving with Mercy Ships the ideas and opinions expressed here are my own. Mercy Ships has not reviewed nor do they endorse the content written within this blog. Thank you to the Mercy Ships Photographers who generously shared their pictures from the screening process.