The USNS MERCY's Southeast Asia Humanitarian Cruise: the perioperative experience

AORN Journal,  Nov, 2007  by Linda Troup

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CHARACTERISTICS OF PATIENTS. In the first ports of call--Zamboanga City, Jolo City, Tawi Tawi, in the Republic of the Philippines--patients held predominantly Christian beliefs. At many other sites that the MERCY visited, Islam was the most common religion. Muslim preferences were respected, and female health care providers were present whenever female patients were cared for in any part of the hospital.

All age groups were represented in patients that were seen. Translators were used to obtain medical histories and to obtain surgical consents. Luckily many of the onboard staff members spoke Tagalog, the language most commonly spoken in the Republic of the Philippines. There were various Bangladeshi dialects spoken in the city of Chittagong, Bangladesh, and at other sites, which often made translation difficult.

An observation made by the medical staff members was the stoic nature of many adult patients as they underwent invasive procedures--they never complained or voiced discomfort. All patients expressed their gratitude, especially the mothers of small children who required cleft palate or cleft lip repairs. Mothers of Indian pediatric patients often needed much consolation. Many cried loudly and displayed strong emotions as their babies were carried into surgery.

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PATIENT COMFORT. Shipboard temperatures that were considered comfortable for most of the MERCY's crew were intolerable to many Indonesian patients. Sheet warmers were restocked several times a day to meet the needs of preoperative patients in the holding area who were chilled by the ship's 70[degrees]F (21[degrees]C) air-conditioned air.

The onboard menu frequently had to be adjusted to accommodate the diverse population aboard. Food that potentially could contain pork had to be labeled for those who avoid it for cultural or religious reasons. A wide variety of vegetarian food choices always was made available. Providers frequently were seen sitting on the floor mats alongside patients and family members who preferred these lower seating arrangements.

Some visitors were unfamiliar with western-style bathrooms, so diagrams of people correctly using toilet seats were displayed to help prevent some patients from standing on, straddling, and often breaking the toilet seats. Impromptu instructions also were needed for some shipboard visitors to prevent them from using the shower drains for elimination purposes.

UNUSUAL PATIENT CONDITIONS

In Zamboanga in the Philippines, a young local man was brought aboard with a huge nasal polyp extending out onto to his upper lip (Figure 5). He was having increasing difficulty breathing in the OR holding area. With tracheotomy equipment nearby, oral surgeons quickly initiated an unscheduled, five-hour polypectomy, excising nearly nine ounces of polyp tissue.

In June, the OR team emergently cared for a local man from Tawi Tawi with severe abdominal pain who had been in a motor vehicle accident the previous day. After he arrived with a rigid abdomen and rapid pulse, the surgeons performed an urgent exploratory laparotomy that revealed a fractured spleen and old blood loss of more than three liters. Postoperatively, he remained stable and was discharged the following week.