After three weeks of setting up the hospital and pharmacy, surgeries began aboard the Africa Mercy Hospital Ship in Cotonou, Benin eight weeks ago.
By Sandy Hewitt BSc.Phm.
In this field service, I have the help of fellow Canadian pharmacist Sharon Falk from Calgary, AB. We have just completed a round of plastic surgeries, repairing burn contractures, cleft lip and palates, and doing facial reconstruction after the effects of a disease of poverty called Noma (a rapidly progressive, polymicrobial, often gangrenous infection of the mouth).
Maxillofacial surgeries carry on right through the entire field service in Benin, repairing encephaloceles, and removing many different types of facial tumours. We also had a round of general surgeries for hernias, goiters, and other ailments. Because of the lack of proper hygiene and basic healthcare in West Africa, the infections that are treated here are more complex that I have dealt with before.
I am very thankful for the full laboratory services that we have on board and their hard work doing cultures and sensitivities for all of the patients. The IV and oral antibiotics that we are using are sometimes not even available in Canada, which has had me learning quickly!
Due to poverty, even the medications that are available to the Beninois people are not often accessible. When a patient is treated surgically, then followed up in our Outpatient Clinic, they are often given medications to treat infection and aid in their healing process. We need to ensure that whatever treatment they may need on a long term basis is sustainable for them once the Africa Mercy leaves port. This can sometimes be a challenge and sometimes requires a bit of creativity on our part. In an average week, we answer questions that keep us on our toes, like:
- Can we make an inhaler spacer with a mask for an infant?
- Can we make a nasal sinus rinse and suggest a way to administer it?
- Is it possible to make a mild corticosteroid sinus rinse that a patient could make at home with basic low cost ingredients? (the answer is No, not as far as we could find).
- Can you compound liquid Clindamycin, liquid Hydroxyzine or liquid Omeprazole, or how about Premarin vaginal cream?
We are often asking ourselves questions we would never dream of at home, like:
- How long will this medication truly be stable at 35º C during shipping?
- Will a reconstituted antibiotic still be effective when the patient has no means to refrigerate it?
- How long do vaccines actually last at room temperature because it takes nearly two weeks for a cold box courier shipment to arrive?
- We are running low on Povidone iodine ointment, what can we use instead that has such a broad spectrum for plastic surgery wound healing?
I must admit that I love how this keeps me thinking and researching and learning all the time. I dread the idea of running out of necessary items. However, it’s amazing and makes me so thankful when we receive a drug just in time, like the IV antibiotic that cleared customs the same day that we gave our last dose to a patient who only a few days before had been in critical condition in the ICU.
Next week, orthopedic surgeries begin and our hallways will be filled with little children who are having their bowed legs, knock knees and other malformations corrected. Next week also marks one year since I arrived here on the ship and the time has passed so quickly, yet it feels like I have always been here….
Sandy Hewitt is blogging regularly about her experiences as a pharmacist on the Africa Mercy ship.