world, on a hospital ship, I feel like I am in a familiar environment.
My last case of the week on Friday was exceptionally challenging, a large lymphaticovenous
malformation, giving the appearance of a large
breast in a pre-teenage boy. He was being ostracized
and teased. I proceed with trepidation, knowing it
will be difficult and bloody, and the procedure goes
exactly as anticipated. But as I successfully complete
the operation and put in the last stitch, I look at the
team of nurses who have worked so hard, who have
skipped their meals and their breaks, who were so profoundly engaged during the most difficult moments of
the operation, and I offer them a simple but heartfelt
acknowledgement of their sacrifice and skill. I thank
them for being who they are and for leaving the comfort of their homes and coming to this ship of mercy
docked at the “end of the world” to take care of patients
whose language they do not understand and whose
culture they do not share—patients who had no other
options. The personnel of the Africa Mercy OR have
taught me many lessons in a single week, the most
profound of which is the power of camaraderie.
Dispatch 5: It takes a Mercy Ship
Today marks the sixth day after Polly’s operation. She is
looking better and better, brighter and brighter. She is
her mother’s child, but she is also the child of the Africa
Mercy, a testimony to the power of this ship.
Polly is identified by Mercy Ships during one of
their screenings far from Tamatave. I find out about
her before arriving on the ship. Mirjam, the screening
coordinator, sends me her pictures, hoping that a pediatric surgeon might be able to help.
I had opened the electronic file in my office at Montreal Children’s Hospital in a moment of disbelief. The
baby had a rare tumor called a sacrococcygeal teratoma, larger than any I had ever seen. She was born
in November 2015, and continues to grow and thrive
despite this massive tumor on her back, approximately
twice the size of her head. I ask Mirjam to get some
imaging done, which is accomplished by the ship’s
radiology technician, and sent to a radiology group in
Canada for review. I receive the report days before I
leave for Madagascar. I see no convincing reasons not
to attempt removal of this tumor, which will eventually turn malignant and take her life.
Days later, I am face to face with Polly and her
mother. I review the imaging and examine the baby.
She is beautiful, and it hurts to see her mother struggling to hold her due to the mass, which is now
even larger and essentially obliterates her buttocks
and lower back. But it is still resectable. I discuss the
operation and its potential complications with Polly’s
mother. She has no questions. This is the day she has
been waiting for since the baby’s birth.
The Africa Mercy operates at a high level of accountability and responsibility. The ship is not an acute care
hospital. It does not manage major pediatric congenital
anomalies early in life. No tumors like the one Polly
had have been previously resected on the ship. The
Polly’s tumor pre-resection
Dr. Emil with Polly and her
mother during recovery
SEP 2016 BULLETIN American College of Surgeons