This blog submission will be the first of 2 submissions highlighting the experience of Dr. Sherif Emil, Division Director of Pediatric Surgery at the Montreal Children’s Hospital in Montreal Canada. This is where I completed my Pediatric Surgery fellowship training and developed, under his and Dr. Dan Poenaru’s mentorship, an interest and love for the surgical care of children all over the world. For the link to all of the submissions from Dr. Emil, click HERE.
Alana Beres MDCM FRCS(C)
Assistant Professor of Surgery, Division of Pediatric General and Thoracic Surgery
University of Texas Southwestern
Children’s Health Dallas
Dr. Sherif Emil is a pediatric surgeon and Director of the Division of Pediatric General and Thoracic Surgery at the Montreal Children’s Hospital. Over 2 weeks, he was be part of the volunteer crew of the Africa Mercy, currently docked in Tamatave, Madagascar. The Africa Mercy is the world’s largest civilian hospital ship dedicated to bringing hope and healing to tens of thousands of the world’s impoverished populations.
Dispatch # 1: The End of the Earth
If there is ever such a place as the end of the earth, Madagascar would be a good candidate. Leaving Montreal February 24th on a night of freezing rain, I arrive in Paris a few minutes too late to catch my connecting flight to Madagascar. Air France gives me a choice of staying three days in Paris or connecting through three different airlines and two African cities to reach Antananarivo almost 2 days later. Neither option is reasonable. I settle on paying an extra fare to reach Tamatave, the port of the Africa Mercy, through a new route, St Denis de la Reunion, a small French territory in the southern Indian Ocean. I arrive in Tamatave 36 hours after leaving Montreal, tired, sleepless, and jetlagged, only to find my luggage missing.
However, my fatigue immediately starts to dissipate on the first glimpse of the Ship. As I climb the gangway, I think of thousands of patients who climbed these same steps to find hope and healing. I embark to a genuinely warm and welcoming environment. Everyone from the receptionist to the Managing Director greets me with warmth, love, and compassion, expressing their gratitude for my decision to join them. All those I meet in my first few hours are resident volunteers on the Ship, who have been here for months to years. And they are thanking me for coming for two weeks – a truly humbling experience.
Within a few hours, I settle into my cabin, take a tour of the ship, and complete the embarkation paperwork and emergency training. I already feel like part of this community of several hundred people from over forty countries, representing different professions, different cultures, different races, different languages, and different Christian denominations, united by only one purpose – serving the least among us. “Assuredly, I say to you, inasmuch as you did it to one of the least of these my brethren, you did it to me.” Matthew 25:40.
February 29, 2015, 21:45: As I settle in for the night after my first day of work on the Africa Mercy, I find myself marveling at what can be achieved when good people commit to a mission, no matter how hard, no matter how challenging. Yesterday, I had a two-hour conversation over coffee with Dr. Gary Parker, the chief medical officer of the Africa Mercy. Gary is one of those people who strengthen your faith in humanity. A craniofacial surgeon, originally from California, he and has family have called the Africa Mercy home for 29 years. His two children were raised on the ship and were educated in its fully accredited school. Gary has tackled some of the most difficult craniofacial problems seen in the world, and is probably the world’s foremost expert on resection of aggressive tumors and mandibular reconstruction, yet he exudes humility and expresses a genuine desire to continue to learn from others.
A few hours after meeting Gary, I jump into the operating room rather unexpectedly. I came here to perform elective, planned, operations. But in the late afternoon, my cabin phone rings, and I find Chris Elliott on the line. Chris is an American military surgeon stationed in Germany, who is using 75% of his annual leave time to volunteer on the Africa Mercy, leaving a big family behind. We knew we would be here together at the same time, but were unable to connect prior to our arrival. Chris calls me about a little boy who had undergone a hernia repair several weeks earlier by another surgeon and is back with a recurrent incarcerated hernia. The child does not look well, and we rush him to the operating room. My first procedure on the Africa Mercy is an emergency procedure, a great way to jump in head first into a new OR. All goes well. “Chris, there is no better place for two surgeons to first meet than in the OR,” I tell him.
March 3, 2016, 22:00: At the end of the third consecutive long operating day, I leave the port of Tamatave for the first time to have dinner at one of the local restaurants with Dr. Heuric Rakotomala, one of four practicing pediatric surgeons in Madagascar, a country of 24 million people. Heuric has come to the Africa Mercy to operate with me for three days. In addition to providing me with a chance to collaborate with local surgeons and learn from them, our joint work has very special significance.
In late 2008, I arrived at the Montreal Children’s with an ambitious dream, to integrate a low-income country rotation into our pediatric surgical training program. I felt it would give our fellows a unique perspective on pediatric surgical practice in resource-poor areas of the world, and an appreciation for our own resources. With the help of Dr. Dan Poenaru, who had established East Africa’s first pediatric surgical training program in Kijabe, Kenya, we succeeded in creating the rotation and sending Dr. Robert Baird as our first fellow in 2010. The program then evolved into an exchange of fellows between the Montreal Children’s and Bethany Kids Kijabe Hospital. Five of our fellows have gone to Kijabe, and we’ve hosted five of theirs. Heuric was the first graduate of the Kijabe program. Working alongside him on the Africa Mercy in his home country is profoundly satisfying, a fruit of a unique collaboration between North and South.
Heuric is also one of the unsung heroes of Africa, striving to provide pediatric surgical care in the most difficult of circumstances, with major deficiencies in equipment, personnel, funding, and resources. Prior to arriving on the Africa Mercy, he had traveled to several cities to take care of children who needed his expertise. His trip back home will take two days on difficult, dangerous, winding roads through this vast country. His commitments to his profession, his patients, and his country are unquestionable.
Heuric also adds a unique flavor to all our work, particularly ward rounds. The patients are proud to see one of their own among the surgical team. His ability to speak the Malagasy language helps break barriers. The nursing staff welcome him warmly and are grateful for his presence. I am comforted, having him with me in the most difficult and challenging cases. In a continent where children die by the thousands every day of completely curable surgical diseases and anomalies, Heuric and those like him are Africa’s best hope for improved pediatric surgical care.
The rest of the day is spent in the screening clinic, where I see 35 patients with pediatric surgical problems. These patients have been screened all over Madagascar by nursing staff and have been brought to Tamatave at the expense of Mercy Ships. Mirjam Plomp, a young Dutch nurse who has been on the Ship, and frequently off the Ship screening throughout the country for more than 3 years, leads the screening team. I am in awe of what she and her team have accomplished. Their diagnostic accuracy and appropriate patient selection makes my job easy. In addition, the efficiency of the screening process is amazing. I thought I was going to see patients through the late evening, but we are done by 3 PM and moving on to other matters.
I return to my cabin before dinner for a few minutes of rest to find a very special gift – my luggage just arrived after three days in limbo. Everything is intact, including some surgical supplies I will be using in my first elective OR tomorrow. Can it get any better?!