Name: Sue Clynes
Job title: OR nurse/Maxillofacial team leader
Location: Onboard the Africa Mercy
5.45 AM Wake:
My alarm chirps and I quickly turn it off before it disturbs my husband John. I like to get up and spend some time in prayer before I start my day. I then shower, get dressed, and head up to breakfast with my husband and friends in the dining room. I live on board the Africa Mercy, which is a hospital ship giving free operations to the poorest of the poor.
At the time of writing this, we are working in Madagascar. Approximately 450 people from all around the world are living on board so mealtimes are interesting and fun. After breakfast I head back to my cabin, take my antimalarial tablet, clean my teeth, put my hat on and leave for work, which takes me about 30 seconds as I just have to walk down one staircase.
7.45 AM Start work
I like to get to work before everyone else so I can call into the ward and introduce myself to the patients and get the theatre set up in plenty of time. I turn the bed warmer on, and check the theatre lights and the suction unit. By then other nurses start to arrive so I can start to delegate tasks like fetching local anaesthetic and saline. Most staff are experienced theatre nurses but they only come for two to four weeks so have to be guided and supervised.
We also have some who come for eight or 11 weeks or longer so they can also supervise and teach, which is a help as it can be quite exhausting constantly teaching, especially when every two weeks you have a completely new group of people. Actually it’s more like teaching a new group every two to three days as all nurses want to work in ‘maxfax’ during their time on the ship.
The surgeon I work with, Dr Gary Parker, has been on the ship for 28 years! He came to see how he liked it, then met his wife and brought up his family here. He is the kindest person I have ever met. I love working with him.
I have been the maxillofacial team leader for 18 months and at the end of July will have been on the ship for two years. I started training at Middlemore Hospital 40 years ago and left in 1981 to bring up my children. I did some part-time work as a practice nurse but returned full time as a theatre nurse at Mercy Hospital in Auckland in 1996 and was a theatre nurse at Tauranga Hospital for 10 years before joining the ship.
8.00 AM Team briefing
Staff gather for the team briefing on today’s theatre list, which is part of the WHO Surgical Safety Checklist. We first introduce ourselves to each other and everyone in the room is allowed to speak and query anything they don’t understand.
It’s such a valuable tool and so many things are picked up at the briefing. Instrument and equipment requirements are discussed at this time so the surgeon and nurses know ahead of time if there will be any issues with availability.
Today we have three cases. The first patient is a 61-year-old man who had an anterior mandibulectomy three months ago to remove an ameloblastoma (a benign tumour that originates from the enamel on the teeth). He is coming today to have an iliac crest bone graft (ICBG) to cover the titanium plate that we used to reconstruct the mandible. In a certain percentage of cases involving speaking and chewing, the plate will wear through the skin either in the mouth or externally, so on Mercy Ships we endeavour to bring all our mandibulectomy patients back at three to six months and do an ICBG so this doesn’t occur.
It also gives us an opportunity to remove any remaining excess skin that hasn’t retracted. This isn’t removed at the time of the initial surgery as the skin’s memory tightens the skin up so well that the patient will actually end up with facial deformities. This surgery takes about three hours.
The second case is a 23-year-old with a parotid tumour for parotidectomy and the third case is an incisional biopsy of a maxillary tumour. This patient is also 23 and has quite a large tumour that she says first appeared 10 months ago. We are all hoping that it was longer than just 10 months because otherwise she will not have a very good prognosis. If it is not malignant, we can do a maxillectomy, but there is no point doing that if it will regrow in six months (sadly, there is no radiotherapy or chemotherapy follow-up support available).
If it is malignant, she will be referred to the palliative care team and we will pray for a miracle.
Today we have two maxillofacial medical students from Antananarivo (Madagascar’s capital city) where the country’s only maxfax surgeon works. Mercy Ships does a lot of education of health professionals so that once the ship leaves the country, the impact lives on through the ongoing education.
Also in theatre today is a Canadian nurse Mandy (new to maxfax), a Korean nurse Molly who has been in OR for two days, and Esther from Australia who has been in our OR for four weeks so is my right-hand girl. We usually have three nurses in the OR but one theatre isn’t working today so we have an extra. Esther asks to scrub up for the ICBG so that frees me to catch up on some admin. And we should all get breaks today!
12.10 PM Scrub up after quick lunch
I have to snatch a quick 10-minute lunch as thefirst case is coming to a close and I need to relieve Esther, who has been scrubbed all morning and needs to have a proper lunch break. I’ll catch up later.
1.00 PM Theatre break
We don’tusually stop at lunchtime, as it takes longer to get restarted, but the anaesthetic nurse needs to have her break as well so we have a break. During that time, I coach Mandy and Molly about scrubbing for the parotidectomy. Molly scrubs for it and Mandy is to scrub for the third case.
As Esther is to circulate, I have a chance in the afternoon to add some screws to one of the plating sets we found was short on screws yesterday and to replace a drill bit in another set. I have a long tea break during the parotidectomy to make up for my short lunch break. I also start thinking about a recent shipment of boxes of sutures that need to be stored somewhere during my admin day tomorrow.
5.15 PM Back to cabin
I often get back to our cabin before John so check my emails and bank account. I ring him about 5.30 and remind him it’s time to come home. We usually meet in the dining room. Tonight is Tuesday night so it’s ‘Africa night’, which I like but isn’t to everyone’s liking! Chicken with Sake Sake – yum! One of the girls we sit with comments that it looks like it’s already been processed. And plantain!
6.00 PM Laundry slot
We have to sign up to do our laundry. You get an hour slot to use the washing machine and then another hour to use the dryer. There’s someone following you so you have to be on time or you will miss your slot!
7.00 PM Fellowship group
On Tuesday nights I drop into Fellowship Group. There is no Bible study so I don’t get behind and if I am working late (and I often am) it doesn’t matter if I don’t make it. I am getting to meet all sorts of interesting people from all parts of the ship whom I may not normally meet hidden away in the OR. The rest of the time I am surfing the net or reading. We have a great library on the ship so it’s easy to slip up and grab a new book.
In Madagascar some lovely person has paid for us to have fast internet so we are able to watch videos and Skype our families, which is a real treat. Other evenings I go for a walk on the dock with a friend for half an hour that gets us out in the fresh air. Otherwise sometimes I get to the end of the week and realise I haven’t actually been outside.
10.00 PM Sleep time
Should be sleep time but I can’t stop thinking about storing those sutures. So John and I have a talk about them as he is the Engineering Stores manager and is very experienced in managing supplies. I then ask God for wisdom tomorrow as we are a bit overstocked at the moment and I need to do some readjusting of our stores. Then I manage to get off to sleep.
All Africa Mercy crew are volunteers, having either self-funded or, if staying longer, raised sponsorship from family, friends, colleagues, churches or community groups to cover the room and board costs of living and working on the ship. www.mercyships.org.nz