Infant gut problems: primary care solutions
Dr David Metson explains why his stint aboard a hospital ship in a developing world country put the troubled NHS in a more favourable light
I felt virtuous as I climbed aboard the hospital ship docked in the port of Cotonou in Benin, West Africa, back in December 2000. After all, I had volunteered, paid my airfare as well as my crew fees and taken a whole two weeks out of my precious holiday allowance to be there. But the feeling did not last. Two weeks is the absolute minimum stint for volunteers and most work for at least eight months and some for years!
The 11,700-tonne Mercy Ship Anastasis started life as the Victoria, an Italian cruise liner, 50 years ago. But for the last 25 years she has been the largest non-governmental hospital ship in the world. She is now no longer 'luxurino', but more 'youth hostel' standard.
Anastasis is staffed by up to 400 self-financing volunteers from about 40 different countries. The medically-trained provide surgical, dental and primary health care while others work on water and sanitation projects for the poor and disadvantaged of West Africa.
The surgical specialties performed in the three on-board operating theatres are maxillo-facial (cleft lip and palate repair and excision of huge benign jaw tumours), ophthalmic (cataracts, squints, trabeculectomies and enucleation), general (huge hernias and goitres), orthopaedic (mainly clubbed feet) and the newest project, vesico-vaginal fistula repair in women who have been severely damaged during prolonged obstructed labour.
As a GP, I worked in the village clinics during weekdays and at other times I was part of an on-call rota for the crew's medical problems. We were part of a team, including locally-trained health care workers, which was touring small villages giving educational talks on nutrition and basic health care.
As doctors we concentrated mainly on paediatric cases I saw many acutely ill children. The variety of diseases was immense from rickets to polio victims (whose legs were as thin as one's thumb, flexion contractures at the knee made their femur-tibia/fibula virtually parallel), kwashiorkor, malaria and pneumonia.
Shortage of time was always a problem. One day the clinic had already overrun when a translator asked me to see just one more child. He reached out among the sea of arms to bring a mother holding her clammy, limp, semi-conscious one-year-old with grunting respiration. We had little equipment but a quick check with the haemoglobinometer revealed an Hb of less than six.
There was no nearby hospital to admit her to, so we treated her with amoxycillin and chloroquine and prayed with the mother for her survival.
We then left her with the remaining group of disappointed people who we did not have time to see before returning to the ship. Two days later in a nearby village, a woman tapped me on the shoulder to show me the same baby now smiling and obviously better!
I will never forget a charming 20-year-old woman named Bernadette who was admitted for surgery to remove her bilateral cataracts which had caused her to be almost completely blind since she was four. Unfortunately, she was discovered to be an undiagnosed type 1 diabetic.
She and her family were illiterate and poor and therefore unable to afford insulin. Of course there was no point operating on her if she would be dead in a few months from untreated diabetes, but a suitable supply was found and a pastor and his wife from a local church agreed to help look after her.
The operation went well one day she was blind, and the next day she could see! But teaching self-administration of insulin to someone who had never learnt to count because they could not see seemed more complicated than surgery. However, this was achieved and Bernadette is now training to be a seamstress.
My two weeks in Benin were the most fulfilling time of my medical career and so last year, my wife and I flew out to Belize in Central America to spend three weeks on board another member of the growing Mercy Ships fleet the aptly named Caribbean Mercy.
This time my role was working in the village clinics that were usually situated in school buildings. It never ceased to amaze us how within half an hour we were able to transform a sparsely-furnished hall sometimes without electricity into a health centre with designated areas for consultations by the three doctors, a dispensary, eye checks and blood pressure measurements.
During the clinics I saw one-third of the patients but in her admin/pharmacy role, my non-medical wife dealt with all 1,800! We both learnt a few Spanish phrases but sadly did not even attempt any native Indian languages.
None of the malnutrition seen in Benin existed in Belize. A health care system does exist but it is not of a standard that would be acceptable in the developed world. In one clinic we met a boy who had recovered from meningitis but this had left him deaf.
Although audiology and speech therapy were available his parents were unable to afford this treatment so he will remain deaf and mute.
Women with 12 children were not uncommon, often starting their families when they are only 14 themselves. Poverty, male self-interest and the lack of status for women seemed to be at the root of their problem. Contraception services are available in some areas but rarely free of charge; an injection of Depo Provera could cost nearly two days' wages.
I would highly recommend to any GPs the benefits of spending two or three weeks in a developing world country. These may be intangible and unquantifiable but very worthwhile. One gains a new global perspective and outlook on life that perhaps puts the troubled NHS in a more favourable light.
Mercy Ships UK,
12 Meadway Court, Stevenage,
Herts SG1 2EF
Tel 01438 727800
David Metson is a GP in Bracknell, Berkshire