Screening: the highs and the lows...

On Monday I had an early start, reaching the national stadium at 6:45 am for the Africa Mercy Screening day. When I arrived, I could already see hundreds of people waiting outside and I could only see a portion of the crowd. I was excited to be a part of this day, a day of expectations, and a day that was sure to end with much rejoicing. At least, that is what I thought.

After the organizers cleared up a few small issues with ‘extra’ lines, the screening soon began. One by one people entered the stadium grounds; the first stop was the pre-screeners. The pre-screeners asked people their reason for coming and then proceeded to tell them whether or not they could see a doctor. Due to the specific nature of the conditions treated onboard, there are always people that show up at a screening that cannot be helped. The pre-screeners had a tough job, but it was definitely needed in order to effectively screen those patients who were suitable candidates for surgery. I was impressed to see the pre-screeners persevere, patient after patient.

For those with conditions that could most likely be dealt with, the process continued as they made their way past a few more stations to the specialist screening areas: orthopedics, maxillo-facial, plastics and general surgery. It is there that they find out if they will receive surgery. To me it seemed as though this was a critical moment for patients, since the news they were about to hear could change their lives drastically. And it was these moments that were the most meaningful to me.

I was at the maxillo-facial station with Dr Gary, primarily to learn from him. The station consisted of three tables, each with a dentist and a translator to start the screening process. Dr Gary, the maxillo-facial surgeon, rotated between the three, seeing each patient and making a (differential) diagnosis and plan. It was remarkable to work with Gary and discuss/see conditions such as thyroid glossal duct cysts, cleft lips, neurofibromatosis, fibrous dysplasia, lymphomas, TB adenitis, and encephaloceles. He not only has a wealth of knowledge and experience but also worked with such confidence, humility and care for the patients.

Besides the sheer excitement of being a part of such a big undertaking and knowing that many people would be scheduled for surgery, it was awesome to watch the faces of individual patients light up when they heard they would receive an operation. Imagine a dad and his boy smiling when they heard the boy would receive surgery for a growth he’s had since birth. A woman thrilled to hear she could be operated on. A young guy, happy by the mere fact that he was being assessed properly and scheduled for a CT scan for further investigation. A shy 13- year old girl, hearing she can receive cleft lip surgery. It is these moments I try to remember when thinking about the screening, because the joy was quickly overshadowed by the tragic event that took place.

As mid-morning approached, the crowd became impatient and people started pushing forward. Those in the small, gated entrance to the stadium grounds were trapped. To relieve the pressure, a small gate was opened and people ran out, forming a new line. The situation quickly escalated. The pushing and shoving worsened and within minutes a larger gate opened and those pressed up against the gate, flooded out of the small space, onto the pavement. A stampede followed and the consequences were grave.

Within minutes, casualties were brought to the pre-screening area and there was a rush to attend to the victims. Some were in a serious condition while others had fainted or were still in shock after having been confined in a small, overcrowded space. Despite good efforts, one man died that day and 13 more were injured. This was not how it was supposed to end. A day of anticipation, excitement and joy, ended in a tragedy. It was very difficult to carry on but it seemed wise to continue screening those in the stadium. After an hour however, the situation outside grew tense once again and the decision was made to stop screening and leave the premises.

With heavy hearts the 200 crewmembers that put a lot of effort into the day, returned to the ship. Meanwhile, I walked back to the hospital still in shock at what had happened. How did the situation get out of control? Is this the Sierra Leone I know? I was saddened that the screening had to end like this. Saddened for the crew, the family of the man who died that day and saddened for the people of Sierra Leone. I couldn’t help but think that somewhere in Freetown there might be a family waiting for their father to come home, but he won’t. I kept thinking about the patients needing surgery, still waiting outside of the stadium to be seen by a doctor. I think about those who were caught in the stampede and traumatized by what happened. I think of the crewmembers that have come to Africa for the first time and experienced such a tragic introduction to what is actually an amazing country.

Looking back, part of me wishes I did not go to the screening that Monday yet a bigger part of me would not have wanted to miss the priceless smiles of those who heard they would receive surgery. There were highs and there were lows that Monday. However, I know that this is just the beginning; the beginning of something good. Although it was a very unfortunate beginning to the outreach I am convinced that despite all that has happened the Africa Mercy is going to have a huge impact in Sierra Leone and many lives will be changed. I am sure that those in urgent need of surgery will be scheduled somehow, at some point. The ship’s visit has been anticipated for years and now the time has come. Great things are going to happen. For those of you who pray, do pray for the crew onboard the Africa Mercy. This is not an easy time. Pray also for wisdom for those in leadership who are planning the next screening.