IamA Nurse who just spent 3 months aboard the world's largest civilian hospital ship... AMA!

You're a wonderful person for doing this ! How were you recruited for this and how was your employer during your absence ?

I feel lucky for the chance! It's the most positive and patient-focused work environment I've ever been in. It really doesn't feel like work at all.

My employer has been, fortunately, very flexible and willing to give me a leave of absence when I've requested it.

EDIT: Ah, and as for recruiting, my dad actually saw a documentary about Mercy Ships back when I was in University still...sent me a message saying, "Hey, so, you need to do this."

I looked into it, and ever since then had been working towards having the experience and financial stability to pull it off.

Double edit: Just noticed my blatant missed opportunity for a Benin pun.

1800 local professionals received training and mentoring

Can you elaborate on this a little bit? Was this training related to the healthcare, or was it more specific to the professions of the locals?

Yes and yes.

We had surgeons, dentists, and nurses mentored by our volunteers, we had OR checklist safety, neonatal resuscitation, instrument sterilization, to name a few of the workshops we put on.

There's also some other forms of capacity building we're involved in, like agriculture training, and refurbishing and better equipping local hospitals and clinics.

Our aim is to work ourselves out of a job. If we can improve the infrastructure and make it easier for people to access quality healthcare, someday we hope our work will no longer be necessary.

Edit: Whoa!!! Thank you, mysterious stranger.

I've never heard of Mercy Ships before, so thanks for spreading the word! How long do you stay in port? Was it difficult leaving everything behind to do this?

My pleasure! I take every opportunity I can to share about it.

The ship spends about 10 months every year in one country. It is currently wrapping up its field service in Benin, and in a couple weeks will head to the Canary Islands for some repairs and maintenance. At the end of the summer it will be heading to Cameroon for another 10 month field service.

The first time was harder than the second time, for sure, because I knew what I was getting myself into the second time! Being away from family is not as hard as it was a decade or two ago. You can stay in touch so easily, and we are fortunate to have pretty decent wi-fi on the ship. Leaving the ship behind and coming back to "real life" tends to be harder.

Can german doctors volunteer there too? Which specialities do they look for?

Absolutely!! Surgical specialties include Max-Fax, EENT, Plastics, Ortho, Obstetrics, and General, Anesthesia, and we also need Internal Medicine or General practitioners for the non-surgical needs of our patients and crew. They're actually urgently in need of a crew physician right now.

All the positions are listed here. Check under Hospital or OR for the physician positions.

Ah I am still early in German med school (6 years), I just would like to do this when I finished my education and training :)

Ah. Well definitely keep it in mind!

How did the general population of the places you visited view your presence? Did you have to do a lot of outreach? Were most people welcoming or skeptical?

There's definitely a mixed response. Most people, when you're walking around, will say, "Yovo! (white person) Mercy Ships? Ahhh! Mercy Ships!" Definitely widely recognized, in part because we're usually the biggest group of yovos/foreigners in the city in which we're docked.

Screening teams travel far inland to reach some of the more remote and isolated places, and as well print, radio, and TV ads air throughout the country to encourage people with the kinds of problems we can treat to seek out a screening event.

Most people are very grateful for the help. Mercy Ships has visited most countries in West Africa multiple times, so there is definitely a reputation by word of mouth from previous patients. Vodun (the origin of Voodoo) is widely practiced in the region, so some people tell us stories that they were warned against coming to us for help. People say that we cut off tumors and then use them for some kind of evil practice. The overlying attitude, though, is very grateful and appreciative.

thanks!

Thanks for the question!

Is employment open internationally or just from certain countries? I'm a surgical tech in the US and this sounds like an awesome opportunity. Do you know if they require scrubs to be RNs to participate?

I believe you do need to be an RN, unfortunately. There are, however, as I mentioned to someone else, a lot of other positions almost anyone could fill, and you can still be involved in more of a supporting role.

You can check out all the positions here.

You mention that all the volunteers on board pay their own way. If you don't mind me asking, what if any financial costs are there to consider for this type of thing? Also were there ever times where you or the ship were in possible danger?

Sure! If you're from a "western country," you pay $700 USD for crew fees each month you're there. You do get a bit of a discount for longer service, and if you're alumni. Volunteers from developing countries pay 1/2 the usual fee.

Flights are also a big expense, and often cost as much or more than your crew fees.

I've never felt at risk on the ship. Ashore, your safety is almost always up to your common sense and making sure you take reasonable precautions.

Travel in groups. Wear a helmet if you're going to take a zemidjan (motorbike taxi). Dress modestly, especially at night. Keep your valuables out of sight or leave them on the ship.

The only time people have been injured or threatened was when they didn't follow these precautions.

Does the $700 cover the cost of meals?

Meals and accommodation, yes.

How are docs treated? Private quarters?

I believe surgeons all get private rooms. The other doctors I'm not 100% certain, but at most I'd think they'd have 1 roommate.

I know I'm late to this, and I apologise- do the kitchen crew need to pay their own way as well?

Yes, they do.

It is definitely possible to fundraise, however, to help pay for your fees. Donations are tax deductible.

Do you have a weird fascination with veins like my RN girlfriend does?

Baahahah I definitely do.

ugh. gross. she just likes to touch them and poke them and constantly ask if she can put an IV in me or whatever. NO. you guys need to cut the shit.

They're just...so pretty!

Wow that's got to be a tough job, so what does the crew do for stress relief onboard?

8 hour shifts for nurses means you do have a good stretch of down time every day to unwind. We watch movies, play a lot of board games, sports if you are brave enough to go out in 25-35 degree (C) weather...

And occasionally get off the ship for a little dinner out or ice cream. If you don't get out into the real world now and then you can start to get cabin fever.

Do you find yourself more willing to try different foods knowing your going home to a hospital?

Ha, it's nice having that reassurance, but I am still always super careful about foods. Local food isn't usually an issue so long as it's well cooked and doesn't involve raw fruit or veg.

I can't believe you don't go out every night/weeekend! Is it that sketchy?

Let me put it this way.

It's not the sketchy that stops you from going out so much as the incredible heat/humidity, the inconvenience of getting the shuttle out of the port then walking or finding a taxi in the incredible heat/humidity, and the fact that you aren't exactly raking in the dough.

What was your worst/best experience while being aboard your ship? Maybe dealing with a patient or anything in general.

Worst experience was having to explain to a patient that there was nothing more we could do to help.

Best was...kids. Pediatric patients still scare me a little, because they're so much smaller and an error in dosing can be far more devastating to them. But their little adorable smiles make it worth it. Especially cleft lip smiles. They're THE BEST.

Can you elaborate on the problem of the patient?

Oh, I misunderstood if you meant the one I mentioned above.

Sorry.

That patient had an obstetric fistula, and had had so much scar tissue and so little left of her urethra that it was impossible to repair so that she could be continent again.

There's a few main problems treated on the ship - most are chronic conditions which are a serious impediment to quality of life, and most can be treated with one or two surgical procedures.

Cataracts, cleft lips and palates, non-cancerous tumors, orthopedic problems, obstetric fistulas, and burn contractures.

What are your long-term goals?

What were your living conditions like on the ship?

Me personally?

To be able to do this full time would be a dream. Working towards that possibility.

Living conditions are a bit..."cosy," shall we say? Unless you're married or in a very high-up position, you're sharing your cabin with 3-9 other people. Privacy is a luxury. I brought an extra sheet to stick up as a curtain around my bunk, but that's really the only space that is truly your own.

Cool that you're doing an AMA. When I was little I dreamed of working with Mercy Ships. I'm now in Internal Medicine so I think that's less useful to you...

A question: how do you deal with long term follow up? Do you refer people back to their local hospitals? Are they equipped to deal with that? And what's your adverse event rate? I'd guess that some of the procedures you do are quite tricky, and given that you're there only temporarily, handling adverse outcomes in a satisfying way would be quite difficult...

Hey, you should look into joining as a crew or hospital physician! We have physicians who help with screening, follow-up, and treat co-morbidities.

And to answer your question, very delicately. We do our very best to deal with the most complicated and high-risk problems early on during our field service, so we have as much time as possible for recovery and addressing complications. I couldn't give you stats off hand, but we take every possible precaution to try to ensure patients are well on their way to a full recovery before the ship has to leave the country.

We also certainly liase with local hospitals and physicians to arrange follow-up care when necessary. We had a couple patients still on wound VACs last week, and I know a local wound nurse came around to meet them and get a handover report in case it was necessary to transfer them to her care.

Follow-up teams also visit periodically (6 and 12 months I think) to check on long-term recovery.

It's definitely a tricky business, and that is primarily why we only take on cases where there is a high prospect for a positive outcome within the time we have. We don't want to leave people in the lurch, half-fixed or worse off than they were to start.

How's the coffee?

WELL.

I actually don't drink coffee.

BUT the ship is home to the only Starbucks in sub-saharan Africa. All the coffee, tea, and syrup is generously donated, volunteers on the ship are our baristas, and we pay about $0.75-$1.50 per drink, just to offset the shipping costs.

Well well,

I don't drink coffe either.

But the coffee served onboard when it sailed as a ferry is still joked about in Denmark.

Hahha, that's awesome.

Well, the free coffee in the dining room is still the brunt of many jokes.

I'm currently working as an EMT, do you know if there are any BLS positions on the ship?

Strictly speaking, no. Our focus is mainly on chronic conditions, not acute. However, there are plenty of positions that any lay-person can fill (like food services, reception, deck hand, or housekeeping), and you could still be involved in patient care in other ways. Or on the ship's fire team if you have experience there!

Have you met any patients suffering from complication from an abortion? I heard this is common where abortion is illegal.

There were one or two fistula cases where an abortion was suspected, but the patient would never have admitted it. Definitely a lot of stigma in that regard, and likely fear that we wouldn't treat her or would treat her differently if we believed she'd had an abortion.

I just recently got out of the Coast Guard and would be really interested in doing something like this. My job was mainly working with the ships auxiliary systems, sewage, fresh water, fire fighting system, etc. I know that's not really your area of expertise but do you know if those types were also volunteers or was it mainly the medical staff that weren't paid? Also I'm not personally religious but have no issues with working in programs that are. Would that be an issue?

I believe all positions on the ship are voluntary, with the exception of local crew from our host countries which are paid.

You can check out positions and requirements here

There is certainly no requirement of faith as long as you are willing to work in an environment that does place an emphasis on spiritual life. Our crew come from an incredible range of denominations and backgrounds, both religious and non-religious.

One last question, what was the total cost including travel, food, and other expenses so I can ballpark how much to budget? Thanks for the link and the quick reply! And thanks for being awesome and volunteering so much of your time. Go you!

Really depends on how long you plan to stay. This page outlines the monthly crew fees depending on your time commitment.

Flights can be the most expensive part, ranging from $1000-2000 USD roundtrip. I just started using Scott's Cheap Flights so I can keep my eyes open and snap up a good deal ahead of time!

And you're welcome! If you do make the leap, feel free to PM me with any other questions you have. :)

Awesome! Thanks so much! Gonna start thinking about the logistics of going next summer.

Awesome! Summer is definitely the best time to go if you're on the deck/engineering side of things, because that's when all the sailing happens.

Wow, you are just as inspirational as those women you helped. What is one great thing you learned from these women, and how do you look at life differently after this experience?

I learned the power of community. Most of our patients come to the ship looking apprehensive, quiet, and ashamed. Within minutes of arriving, though, the patient on the next bed over will be sharing their story, explaining what all the weird gizmos on the wall do, and how to use the toilet. The camaraderie that develops between our patients is incredible, and that accepting, supportive community around them does more to heal them than the physical repair ever could.

As an American nursing student, this is exactly the type of work I would love to volunteer for! Thank you for your work. How different are infection rates on the AFM compared to hospitals?

Ooooh, great question!

There is definitely a higher rate of wound infection, thanks to a couple of factors. Poor nutrition = slow healing, slow healing = increased risk of infection. We do our best to help healing along with nutritional supplements. There's also not a ton of space, as you can imagine, on a ship. "Standard precautions" and hand hygiene practices are hard to enforce, especially when your patients are this close together, and there's babies crawling and drooling all over the floor half the time.

I don't know stats off hand, but I know we typically had at least one patient with MRSA in their wound at almost all times.

Ah, I should also mention the heightened precautions we took being in West Africa since the Ebola outbreak, and recent outbreaks of Lassa Fever and other highly infectious viruses.

Every person entering our berth space in the port had a temp check, and handwashing was mandatory before coming aboard.

Patients are screened for malaria, and for a history of travel in high-risk areas.

First off let me say that you are an amazing person for doing what you have done. Secondly Stargate is by far the best TV show to have ever existed. Well Battlestar Galactica comes up right behind it. And so you are that much cooler for having an awesome username. Do you have any pictures of the ship? This way we can get a better view of your experience.

Haha, I salute you for your wise choice in fandoms. ;)

As for a picture, there's one in the AMA description! But if you want a more in-depth view of the Africa Mercy, here's a virtual tour!

Awesome thanks I'll check it out. Started actually did a pretty good job at trying to keep things as scientific as possible period actually learned quite a bit from that show Growing Up. I remember there was one scene where Samantha Carter was in front of a massive chalkboard with equations on it and all of the equations were accurate. I can't remember which episode it was but the chalkboard was probably about 20 feet high. Anyways bye.

Haha. Yeah, I know Amanda Tapping (the actress) made a concerted effort to understand everything she said or wrote and make sure it was accurate!

Does the ship jump from dock to dock in Benin and send out dinghies to get the patients, or do most patients come to the ship in their own vessels?

Also, what advertisements do you use, or is it more word of mouth?

The ship is docked in a port where you can walk on via a gangway. We do help cover transportation costs for patients who live far out of town, and sometimes drive them ourselves if need be.

TV, radio, and print ads are used, but word of mouth is definitely still the most effective at reaching very remote areas.

Two part question: What is your favourite Stargate episode, and why is it Window of Opportunity?

I...actually think it's a tie between Window and 200.

I know, I know, I know! But 200 was pretty stinking awesome too. I mean...

Just

So

Good.

...3 fries short of a Happy Meal...

I don't know but that just happens to be how I feel about it.

How do patients find out about the ship or do you find them somehow?

We do send teams out to major towns inland, but we also use TV, radio, print ads, and word of mouth.

The ads explain the types of problems the ship is equipped to fix.

Male RN retiring after last 25 years in the ICU....what a life I've had! My deepest respect to you for going out into the world in such a special, humanely way. Did you have trouble communicating with your patients bc of the language barriers? (if there were any at all...)Really opens the eyes of the soul does it not? (being a nurse) Good fortune to you luv....

Language barriers are a huge challenge. There are about 50 different languages spoken in Benin alone. Patients coming from more northern parts of the country, especially, would often speak a dialect that few or none of our translators could speak. If we were lucky, another patient would be able to translate into French, or a more common language, then our translators would relay it back to us.

On more than one occasion we had 4-way translation going on. Really gives you time to think about what you're going to say next!

What other types of professions can volunteer? Are all volunteers medical professionals or are a range of other professions/ trades etc required for running the ship and it's equipment?

Just about anything and everything is needed.

Engineers, electricians, sailors, teachers, cooks, cleaners, receptionists, security, carpenters, plumbers, IT, financial and HR...it's basically a tiny city that floats and it needs just about everything a city does to run.

All the positions can be found here.

Awesome thanks. I'm an electrical engineer and would love to do something like this.

Awesome!

Are you paid?

Nope, we pay to be there!

But this doesn't make sense? I thought they needed staff to work the ship?

All the crew are volunteers, and we all pay crew fees to cover the costs of our accommodation and food.

I had thought it would be cool to do for a bit. I could take a month and paying my travel and stuff...but I'm in IT and the current position I'm qualified for they want 2 years. I most definitely cannot afford to take 2 years off!

You could certainly try to apply or email one of the crew coordinators to discuss it. If the need is urgent, they would be more likely to take any time you can give.

what made to you decide to do this?

I knew I wanted to do some sort of relief or humanitarian aid work eventually. That's why I became a nurse.

I ended up liking surgical nursing, got my first job there, and it all just seemed to line up really well with the work done by Mercy Ships.

Think about going to Columbia or Venezuela?

Me personally, or the ship?

you personally

Not at present.

What were some of the complications to surgery and general care caused by being on a boat? Were any of them overcome in notable ways?

Well, there is some mild but noticeable rocking, which occasionally caused me to lose my balance trying to crouch to empty a catheter. That's always a precarious situation!

I imagine it does add a degree of difficulty for the surgeons, trying to make precise, steady cuts when they're swaying back and forth.

The odd patient would also experience a bit of motion sickness, but it wasn't like we were really pitching, we were well moored in a port so the movement was fairly limited.

One of the other challenges is simply the location of the hospital on the 3rd deck of the ship. There are no windows or outside doors that far down, so we have to walk our patients up 4 flights of stairs each day to allow them some fresh air and exercise. For those who can't walk, it's a real sketchy cargo elevator ride.

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There are precautions, screening, and protocols in place to protect the ship from infectious diseases, absolutely. The last two field services were in Madagascar because the risk of Ebola was too high in the countries in West Africa, and a ship is like a little powder keg of infection waiting to explode if anything got on board.

There are also reasonable precautions you can take to keep yourself safe. Wear modest clothes, avoid certain areas, never go out alone, don't go out at night often, and if you do only in large groups. I can't speak to Liberia specifically as I've not been there, but these are generally good rules of thumb to follow.

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I did have some fairly burly deck crew with me most of the time. ;)

A family member works there atm, but he tells me there are some strange things going on like patients will only be treated if they are Christians, Muslims are turned away. That's a bit odd isn't? He also tells me drinking alcohol is forbidden, but of course it still happens. What do you think about the strict rules?

Well, I think they're exaggerating. We've had many muslim patients on board, even setting up a prayer room in an empty ward for them.

The ship is dry, but it's not a problem to have a drink with dinner off the ship.

The rules are a bit strict, but this is because Mercy Ships holds its crew to a high standard, and wants to maintain a reputation of integrity among the host countries.

Ah yes they told me they heard it from someone in Benin, I think there's more to the Muslim story than my family member knows. I understand they want to maintain there image, still it sounds a bit strict to me, especially when you are months on end aboard and are not allowed to receive visitors of the other sex in your room or have a fun night out with plenty of drinking. But maybe it's because there are a lot of young people working there and they want to keep them in check. Still I find the stories about the ship quite outlandish, because of Christianity being so overly present, mandatory church/prayers in the morning etc. But good work, lots of good stories too.

Church also isn't mandatory...there's only one mandatory meeting and it is purely informational updates for the week. There is usually one worship song and a prayer at that meeting, but the church services aren't mandatory.

That said, faith is a huge part of how and why the ship works. I can understand it being challenging for someone with different beliefs. From my point of view, though, there's a very open and accepting atmosphere among the majority of the crew, regardless of your beliefs.

So the original purpose was to spread Christianity ( according to Wikipedia) "Youth With A Mission".

I'm wondering when some of these patients convert what version of Christianity to they adopt? I imagine you probably understand the importance of birth control and treating homosexuals like regular people but.. how does that message get across to the patients? Can they freely find bibles on the ship?

Not trying to be confrontentional I'm just wondering what kind of beliefs new converts might take with them should they find God through medicine.

So the existing belief system of many people in West Africa is an amalgamation of local traditional beliefs, like Vodun/Voodoo, and more widespread religions, like Islam and Christianity. While yes, Mercy Ships sprouted out of YWAM, an evangelism-focused organization, that is not the primary goal of the ship. We do offer Christian chaplaincy services to our patients, and Bibles are indeed available freely, but we also endeavor to accommodate the diversity of our patients. The ship, after all, becomes their home while they are with us.

Our aim is to share God's message of love through our actions and service, and that usually speaks louder than words.

what is the worst case you've had to treat?

what is the most inspiring story from the ship?

what's your favorite song?

The last time around I helped care for a woman with a massive tumor growing inside her mouth. It had gotten so large, and was bleeding so much inside her mouth that she was beginning to have trouble breathing. If she hadn't been waiting to come aboard for surgery, if she had been at home still when that had happened, she almost certainly would have died. She was rushed in and given an emergency tracheotomy (breathing tube in her neck) and scheduled for tumor removal a few days later. She still kept having bleeds, and we had to hold pressure inside her mouth to stop them. By the end of her surgery she'd had more than double her blood volume replaced.

Most inspiring moment for me was when I told my isolated patient that she could go home. She refused to go because it would have left the young patient and her mom in the iso room next door all alone.

Favourite song...is a toughy. Hold On by Walk Off the Earth is probably one of my most recent favs.

What was the nasty, gross, cringe worthy part of your job? What was the worst stuff you saw?

Compared to where you grew up, how much is overall health of people different?

I mean, I think I honestly see grosser stuff on a regular basis at home. Generally speaking, there's not a lot of obesity, and therefore not a lot of the chronic disease that goes along with it. Mild to severe malnourishment is fairly common, and probably 1 in 5 adult patients still have high blood pressure, but other than that people are fairly healthy.

Poor nutrition does mean surgical wounds, and grafts especially, take a really long time to heal. So we work really hard to boost their system up with nutrition supplements.

One of the grossest things I saw this time around was probably a fat graft under the cheek that was oozing out through the eye. Fat from the belly is injected under the skin where bone and other tissue have been grafted to help boost the healing, but when the fat breaks down it's just this slimy, oily, mushy goo. The patient had lost their eye to a tumour, and the fat was coming out from where the eye used to be. Yumm.

Who or what inspired you to become a RN?

Partly it was practical. I wanted to get into a medical field, and nursing gave me the most opportunities with an attainable amount of education.

I do have several nurses who I've known since I can remember, who are great inspirations to me. One in particular spent most of her life in a remote village in the D.R. Congo, improving their infrastructure and caring for their sick, delivering babies, etc. She was an incredible woman and I couldn't hope to be 1/10th of the nurse she was.

Why do Western Africa nations lack good medical care? Wars, lack of government funding, lack of medical professionals, corruption, no one wants to invest in private medical care there?

Yes, these are definitely contributing factors.

Lack of infrastructure is a huge issue - from some very remote regions it can take days of walking to reach any kind of health care center. There's not necessarily any such thing as an ambulance in many places. And if there is, they are more like a body retrieval service than anything. There is, in some areas, distrust of "western" medicine as well. And just in general, sub-saharan nations are quite poor, some of the poorest countries in the world, with the average person earning ~$1 USD a day.

Sub-Saharan Africa is a large portion of the Continent. Isn't Western Africa in worst shape to care for people medically than Central, Eastern and Southern Africa?

It's bad in West Africa, but also across most of the continent. Check out this WHO data - showing the number of physicians per 1000 people.

How often are you on Reddit and what are your favorite subreddits?

I reddit a fair bit!

My favs are probably HighQualityGifs, Outside, PhotoshopBattles, and CriticalRole

What is your favorite episode of Stargate?

Ha, you didn't add "and why is it Window of Opportunity" like the last person. xD

Window and 200 are tied for top place for me.

From did the ship get clean water?

The port usually has a freshwater supply we can hook into. However, especially in developing countries, it's not particularly safe to drink. We have our own water treatment system on board, and can store ~1,000,000 liters of safe water.

Ur job looks amaaaazing except for the paying part :D , do u get paid if u get a long time contract later?if yes,how do u get that? U r kinda working for free atm unless i got it wrong, Can u explain this please?

Nope, all the positions on the ship are volunteers. Mercy Ships is a very unusual charity, in that its volunteers pay for all their own expenses, and as such, it has always operated in the black.

The crew paying their own fees means more of the organizations donated funds can go directly to operating costs and supplies.

Sounds like a shitty charity

78.9% of funds are spent on actual programs and services.

As far as charities go, that's pretty freaking good.

To work for

The point of working for a charity is not generally to make big bucks.

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The situation in the US is not quite as desperate as that of most of Sub-Saharan Africa.