BRAZZAVILLE SCREENING - AN ENGINEER'S PERSPECTIVE

At 0545 we arrived. The police checkpoints were in place - a good sign. Only those potential patients who had been pre-screened and selected by 11 Congolese hospitals and medical centres were to be let in. This would make our job of maintaining security within the screening site far easier throughout the day.

Potential patients and caregivers waiting patiently and hopefully outside the selection site

Then as we rounded the corner we saw the queue of potential patients and caregivers sitting patiently, expectantly and hopefully under the tents. My heart leapt. This was why we were here.

Potential patients dressed in their best clothes waiting to be screened

The first 10 potential patients were escorted in at 0630. From my station at the exit gate I was able to see the patients and caregivers being greeted by our amazing Academy French teacher, Myriam Kormann. Throughout the day she joyfully and reassuringly greeted every patient and caregiver directing them to the screeners. She told me she took breaks but I never saw her leave her station.

Myriam in the "maillot jaune" - what a super heroine!

Then I saw the first patients being directed to registration and my heart soared for I knew this was a sign that there was good chance we could help these people. But of course soon some were directed straight out from the screeners and my heart broke a little every time for these people.

A potential maxillofacial surgery patient

Although this was my first screening,  I had been preparing myself for the "no's" - those people that we could not help either because their condition was not treatable or not one that we were equipped to treat onboard. But blessedly there were far fewer "no's" and many more "yes's". This was primarily due to the prescreening by the Congolese hospitals and medical centres. Early in the day the yes's seemed to outnumber the no's by 10 to 1 however the final count at the end of the day was about 60% accepted. Still a very high percentage.

Fellow Australian, Rinnah Fry, was part of the screening team

Normally Mercy Ships has a prayer team to sit and pray with the "no's" but due to the limited number of people we were able to bring to Brazzaville there was no prayer team. As you can imagine everyone preselected to be screened was full of hope and to be rejected was crushing news. Some were graceful, some resigned, some disbelieving, some broken hearted and a few were angry. So  the exit gate team had some challenging situations to manage, with some angry and disappointed people. My French is good enough to answer simple questions and give directions but not up to explaining to a distraught parent why their child could not be treated. But our Congolese day crew interpreters, particularly Saul from the eye team, were fantastically gracious and calm in explaining repeatedly why people were unable to be treated.

Perhaps the ones that I found hardest to accept were the children with clubfeet. This is a treatable condition but is not being done this field service. One mama with her son obviously knew his condition was treatable and was very upset that he had been rejected for treatment. I held him for her as Saul explained that we did not have a doctor able to treat her son. Apart from one foot, he was a healthy boy and I now wonder and pray that he does get a surgery in the future to correct his foot.

A beautiful Congolese girl who will grow up without a cleft lip

Throughout the day I was most touched by the parents with their children. I was constantly reminded of my own children and how as a parent I would do whatever I could to seek treatment for them if they were sick or handicapped. I fully understood their motivation and it gave me joy every time I saw one leaving clutching their precious yellow appointment card. But it tore at my heart every time I saw one leaving without that card.

Yes!

Very happy Papa!

Another amazing thing was how well dressed many of the people were. I don't dress up to go to the doctor but many of the Congolese seemed to be wearing their Sunday best outfits - bright and beautiful.

By about midday we had finished screening all the preselected patients and the decision was made to check the street barricades for any obviously potential max-fax or cleft lip patients. There were several of these and then at about 1330 a young man with a cleft lip appeared at the exit gate. He was about 16 and wearing a red shirt. We asked if he should be let in and were given the go ahead. He was the last screened and put on the standby list. I hope he gets his surgery and if he does he will be one of the luckiest guys in Brazzaville. Not prescreened and miraculously let through the barricades in time to be admitted before we wrapped up for the day.

The Brazzaville Screening Team

The statistics from the day: 522 potential patients through the gates, of which 294 were scheduled for Surgeon Screening in Pointe-Noire and hopefully surgery onboard.

By 2 pm we were finished and a group of us headed out to check out the Congo River rapids below Brazzaville. These were spectacular but I found I was both emotional and physically exhausted and happy to just sit, watch and unwind. Later that afternoon we headed back to the airport to catch a plane to Pointe Noire and our wonderful floating home we share we so many fantastic and generous people from all over the world.

Exit Gate Security

How Often Does Your Dentist Save Your Life?

Last Saturday as we watched the kids play beach soccer I chatted to the Lead Dentist, Mark Bullock, about his week. I thought I had had a tough week and was tired after being duty engineer Saturday and Wednesday, bunkering late on Wednesday plus some frustrations completing some planned maintenance checks. Then Mark told me about his week which was the usual of many patients and tooth extractions but included a particularly challenging patient on Thursday. To give an idea of how busy they have been, they seen about 1400 patients and conducted about 3100 dental procedures in 7 weeks up to 19Oct13. How does that compare to your dentist?

How often does your dentist save your life? For most of us the answer is never. Last Thursday a patient arrived at the dental clinic after patient screening and selection had completed. However the guards could see the man's need and admitted him. Well this man had a very serious dental infection that had caused pus to accumulate beneath the floor of his mouth. Mark described it as grapefruit sized and pushing his tongue up three inches. This was resulting in his airway being almost completely blocked. The man could barely breathe and could not lie down as this completely blocked his airway. This guy was seriously in immediate danger of dying....from a tooth infection.

So the most immediate concern was to reduce the swelling in order to clear the his airway. To do this Mark needed to extract the tooth or teeth causing the infection. But which teeth? They all looked bad which is apparently pretty common. Anyway the man was able to tell Mark which side the infection started so he targeted the worst two teeth on this side. Oh, and by the way, they are not set up for general anaesthetic at the dental clinic so the whole procedure was done under local anaesthetic. Well Mark and the other Dentist - Annette - chose correctly and found pus under the extracted teeth. This allowed some immediate relief but as pus does not drain up (it's a gravity thing) they also had to establish a drain to drain the pus out which they did successfully. I didn't quite understand the mechanics of it (being an engineer and not a dentist) but it sounded challenging enough. After this the man was able to swallow and was given antibiotics then and there before being sent home.

The man was given instructions to go return the following day for a follow up check and if it worsened overnight to go to hospital. However Mark had a sleepless night worrying about his patient who was okay and turned up on Friday. He was given the same instructions for the weekend and told to return Monday morning to be checked again, which he did and he was fine.

So I don't know this man nor what he does or if he has a family. But without Mark's skill he almost certainly would have died. And if he had a family, they would have been without their primary breadwinner. And maybe others were reliant on him for their jobs too...so the impact of his death would have been even greater.

Mark out walking with us when we first arrived in Congo

And Mark couldn't be here without the support of his family and friends who provide support to his family. But Mark has a family of three boys all attending the onboard school so he could not be here without the presence of the Principal and teachers, who are all volunteers too, supported by their families and friends. And my small part in this process is maintaining the life boats, pumps, sewage plant and safety systems that keep the ship running safely. So even though the engineers, deckies and academy staff don't directly contribute to saving and changing lives in Africa, it is satisfying to know that we all played a small but important part in our Lead Dentist being here to save this man's life.

Post Script - After only seeing one such patient in Guinea last year, Mark had two more cases similar to this one this week. All were successfully treated and are recovering.