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Industry: Email Alert RSS FeedThe USNS MERCY's Southeast Asia Humanitarian Cruise: the perioperative experience
AORN Journal, Nov, 2007 by Linda Troup
What is it like to apply perioperative nursing skills aboard a huge, seafaring oil tanker converted into a hospital ship? Imagine being a crew member of a massive, floating medical facility with a 12-room, state-of-the-art surgical suite. The ship cruises to exotic yet undeveloped Asian ports so health care providers can care for thousands of poor, underserved people in dire need of surgical assistance.
South Asia is the second most poverty-stricken region in the world, preceded only by sub-Saharan Africa. (1) According to the World Bank, the region "is home to almost half of the world's poor." (2) Of a population of 1.3 billion, 85% live on the equivalent of less than $2 a day, and the average life expectancy is 63 years. (3)
Southeast Asia has one of the highest illiteracy rates, and poverty is endemic, especially in Indonesia and the Philippines where the disparities between rich and poor continue to grow. Of the many facets of poverty, which include constant hunger and lack of paying work, perhaps the most tragic and compelling is not being able to get medical or surgical care when it is urgently needed. In rural, remote areas, physicians and hospitals are simply too far away, and suffering becomes a way of life. In such places, one encounters diseases and conditions that, in more developed regions, would be addressed and resolved quickly.
Although many charities visit underprivileged regions and provide medical and surgical help, the mission described in this article was unique in its size, diversity, and complexity. The five-month mission on the US Navy hospital ship the USNS MERCY began in Zamboanga City in the Republic of the Philippines, and the ship traveled throughout the Philippines and Indonesia, concluding its journey in Dili, Timor-Leste (ie, the Democratic Republic of East Timor). During the voyage, volunteers treated patients on board in the MERCY's state-of-the-art facilities as well as in local clinics and hospitals throughout the region. The effort was so successful that similar missions are being planned for additional sites in the future.
DIVERSITY AMONG CAREGIVERS
This particular mission aboard the USNS MERCY began in April 2006 with 190 physicians, dentists, nurses, and corpsmen, mostly from the Naval Medical Center-San Diego, California. Several Army, Air Force, and Public Health Service officers from around the United States and the Pacific Region also participated. Civilian mariners comprised the manpower that ran the ship. Military health care providers from India, the Republic of the Philippines, Hawaii, Canada, Australia, Malaysia, and Singapore provided additional support, as did nongovernment officials from
* The International Relief Team, San Diego, California;
* Aloha Medical Mission, Honolulu, Hawaii;
* CARE, Merrifield, Virginia;
* Tzu Chi Foundation, Hsiang, Hualien County, Taiwan, and San Dimas, California;
* University of California-San Diego PreDental Society;
* International Organizations for Migration, Geneva, Switzerland;
* Save the Children, Washington, DC;
* International Committee of the Red Cross, Geneva, Switzerland;
* Project HOPE, Nablus, Palestine; and
* Operation Smile, Norfolk, Virginia.
[ILLUSTRATION OMITTED]
These diverse and compassionate people joined ranks with members of the US military and converged for a common mission of kindness to help those in great need of medical and surgical care who otherwise would not receive it. Throughout the mission, the procedures performed in the OR consistently demonstrated collaborative cultural diversity. The surgical team, composed of both men and women, could comprise a surgeon who was American or Filipino, assisted by a surgeon from India or Malaysia, with an American or Asian anesthesia care provider and surgical technologists and nurses who were Hispanic, Australian, Asian, Caucasian, African-American, and Indian.
THE USNS MERCY
The USNS MERCY (T-AH 19) is a pristine, white, 1,000-bed hospital ship with three giant red crosses painted across her hull, communicating her purpose (Figure 1). She was used successfully for humanitarian assistance immediately after the December 2004 Indian Ocean tsunami and later returned to the same sites that previously were visited. The MERCY has 14 inpatient wards and a huge casualty receiving area for triage purposes. The shipboard environment is very clean and organized but noisy with the incessant hum of the ship's engine. For safety purposes, when helicopters arrived transporting patients and supplies, there were frequent announcements of flight quarters (ie, a ship configuration where personnel are assigned and stationed at critical positions to conduct safe flight operations). The ship's main deck is 10 ft wide, but most passageways are narrow. Personnel must climb ladders to reach patient care areas, which include several wards. The few existing elevators are used only for patients and cargo.
[FIGURE 1 OMITTED]
SURGERY AT SEA
The onboard Central Sterile Receiving (CSR) Department offered multiple specialty instrument sets; however, during the mission detailed here, no endoscopic procedures were performed. Decontamination and processing of instrument sets was accomplished using a dumb waiter system from the OR on the main deck to the CSR department, located one deck above. Procedural supplies were transported by means of a cart system. All mobile hospital equipment had to be secured or tied down with ropes to prevent damage during potential high seas (Figure 2). In the OR, back tables, suction canisters, electrosurgical units, and anesthesia machines were all tied to the deck. On the bulkheads and decks, large metal D-rings were ubiquitous for quick and easy tying of equipment and gear.
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