There Are Too Many Children!

We aren’t allowed to take pictures on the wards, which is probably a good thing because no photograph could really capture the difference between our general surgical ward and the pediatric orthopedic ward.

Our ward is quiet. Very quiet.

It is mostly filled with cranky men who have one primary goal: go home. Our patients generally stay for only 24 hours, so every morning we have the four patients we operated on the day before, and by afternoon, four new patients arrive for surgery the next day. It is a rather predictable rhythm—surgery, recovery, discharge, repeat.

Picture of the empty side of the general surgery ward.  We have three bays, with six beds in each.  Honestly, there isn't much difference between this empty side and the side with the patients in it! Our ward is pretty quiet and orderly - even with occupied beds. You can see under each bed is a mattress that the patient caregiver sleeps on. 

The pediatric orthopedic ward is an entirely different universe.

It is a hive of activity. The children stay for several weeks, so the census grows by two every day. Every child has a caregiver who stays with them around the clock and sleeps on a mattress underneath their bed. The kids are propped up in their beds with colorful casts on their legs. There is music playing, games happening, and dance parties breaking out for those who are able to walk. In the evenings, Disney movies are playing.

Basically, it is a pediatric orthopedic ward by day and a combination of summer camp, daycare, and movie theater by night.

This weekend, three of our gentlemen had to remain in the hospital for various reasons. On Saturday, the two wards were combined, and when I arrived Sunday morning, I found our three men on the pediatric ward.

I barely had time to say good morning.  Before I could ask a single question, each of them independently announced: “I am ready to go home!”  One man looked around at the general chaos and announced: “There are just too many children!”

I couldn’t help but laugh. These three men had experienced, firsthand, the stark difference between the two wards.  Apparently, they had reached their limit.

The children seemed perfectly happy.

Our gentlemen?

They were ready for discharge immediately.

Apparently, Hernias Aren’t Very Photogenic

Here on the Global Mercy, I spend my days fixing inguinal hernias.

And yes, I know—it IS important work.  These hernias can be large and painful. They can interfere with work and daily life, and if something becomes trapped inside the hernia, it can turn into a surgical emergency. For a young, unmarried man, a large hernia can also be embarrassing and, in some cases, may affect his prospects for marriage.

So fixing hernias absolutely matters.

But let’s be honest… it’s not exactly the kind of surgery that makes people say, “WOW! THAT IS LIFE-CHANGING!”

Meanwhile, just next door, Dr. Racheal Buckingham and the orthopedic team are doing surgery that is almost impossible to describe any other way.

Their kids come walking up the gangway with severely bowed legs, knock knees, and ankles and hips that have become twisted from years of walking on their deformities. Many have rickets—a bone-softening condition caused by deficiencies in vitamin D, calcium, or phosphate—or Blount disease, a growth disorder of the shinbone.

Then the orthopedic team gets to work.  And after surgery and recovery, the kids leave the ship with straight legs.

It’s hard not to think about what that can mean for the rest of their lives.  Maybe they will run when they couldn’t run before. Maybe they will play with their friends without being stared at. Maybe they will go to school for the first time without worrying about how they walk. They will now grow up with possibilities that once seemed completely out of reach.  That is pretty incredible.

The communication team has produced some wonderful patient stories over the years, and I’ve included some of those videos below.

Malang's Mercy Ships Story

Mariama's Mercy Ships Story

Djazim's Mercy Ships Story

Sira's Mercy Ships Story - YouTube

This week, we had a young orthopedic patient being followed by the communication team, so there was lots of activity next door. Cameras, filming, interviews—the whole production.

Our room, meanwhile, was sitting quietly next-door fixing hernias.  And honestly, we were starting to feel a little neglected.

Not ONE person from the communication team came into our OR and said, “Would you like us to take some before-and-after pictures of those hernias?”

Apparently, a dramatically straightened pair of legs makes for a much better story than a dramatically improved groin. 😂

And honestly, I get it. “Here is a large hernia. And here it is… no longer there.”  Just doesn’t have quite the same cinematic appeal.

But maybe that’s okay. Not every important surgery comes with a great before-and-after photo.  Sometimes you just quietly fix the problem, send someone home without pain, and move on to the next patient.

And sometimes you straighten a child’s legs and give them an entirely different future.

Either way, it’s pretty special to be doing this work on the Global Mercy.

Finding My Rhythm on the Ship

I feel like, on the clinical side of things, I have started to hit my groove on the ship. I know the routines of the operating room, how the wards work, how they would like us to round on patients, and how they want us to consent for surgeries.

Last weeks OR staff.  Three operating rooms were running with a general surgery, orthopedic, and ophthalmology teams.

We had lots of accents in the general surgery room last week!  From left to right: OR nurses from Sweden, Australia, and Switzerland. Then the anesthesia team from Northern Ireland and Netherlands.  At the far-right is Dr. Shutt the other surgeon from the Island of Man. 

However, on the social side of things—the living life on the ship side—I am honestly a bit stressed out.

The thing is, the social side of the ship never quits.

At home, I am used to going to work and then going home. A few times a week, I might go out with friends for dinner or hang out with my neighbors on the back porch. Maybe I’ll run by my parents’ or sisters’ houses for a visit or pick up a niece from an activity. But there are starts and stops to those activities.

If I have had a long day, I can choose to go home, change into my PJs, sit on my couch, eat my dinner, and not talk to anyone else that day.

But here, you just can’t really do that.

You go to the dining room for all your meals, which is this weird little microcosm of people who have been on the ship for a long time and have their established cliques, mixed in with new people who are just trying to find their way—and a place to sit.

Honestly, it feels a lot like the middle school cafeteria.

I have tried to become braver about it. If I see a table with an open chair, I’ll just ask if I can sit down. But then there are days like yesterday. We had a really long day in the OR, followed by seeing our patients for the next day. I had a headache, my back hurt, and the idea of making small talk with strangers sounded absolutely exhausting.

But do you want to be the weird person who got their food and is sitting alone?

Not really.

The mornings are tough, too. I am not a morning person. I just want to get up, get my coffee, and not be bothered for a little while.

At home, my OR team knew that I would come in cranky and that it was probably best not to talk to me too much during the first case. By the second case, I was ready to go!

Here, I have to get up and go to the dining hall for breakfast. It is loud, everyone is yelling “GOOD MORNING!” to everyone else, and I am barely awake and absolutely not ready to engage with the day yet.

Then there are all the different things to do in the evenings on the ship. There are always activities happening, and you almost feel obligated to participate. But after a long day in the OR, sometimes you just want to put your feet up and read.

I would describe myself as an introverted extrovert. I have plenty of outgoing, social traits and can absolutely turn on my extroverted self when I am at work or at a gathering. I can be a social butterfly.

But it drains my batteries.  And then I need time to recover.

That is the part I am still figuring out. Living in a community on a ship means that there isn't always an obvious place to step away from the social side of life. At home, solitude is easy. I can close my front door, put on my pajamas, and disappear into my own little world for a while.

Here, everyone is just…there.

All the time.

But I recently found a posting for an activity that I thought was absolutely brilliant. It was called “Having Time Alone—Together.”

Once a week, one of the lounges is reserved for people who want to individually work in community, in silence. You can bring a book, your computer, a project—whatever you want—and just be around other people without actually having to be social.

Tonight, I am writing this blog alone in my cabin. But maybe later this week I will go there and write my next blog in the community of others, without the pressure of having to particularly socialize in that moment.

Honestly, I think that might be exactly what I need.

And I have also solved one of my other major problems:

Early breakfast!

I recently learned that two industrious teenagers onboard will deliver your breakfast to your room on Saturday mornings for the small price of just $2!!!

As my Welsh Fam girls know, I love a good breakfast delivery.

I will 100% be taking these girls up on their services starting this weekend.

Reflection on my first week

It has been a very interesting first week on the Mercy Ships. There has been a lot to learn—not only about how the ship operates, but also about how medicine and surgery are practiced in this unique environment.

There have definitely been some challenges along the way. Here, every case is performed with two surgeons working together, which has been interesting—and at times a little challenging—for the other general surgeon and me. We’ve had to learn each other’s techniques, habits, and surgical styles, and there are inevitably moments when we approach the same problem a little differently.

Since I’m new to the organization, he is also essentially here to evaluate my skills as a surgeon. I’ll admit that can make me a little nervous at times, especially when we find ourselves doing something differently. It’s one thing to be confident in your own experience and technique, and another to have someone watching closely and evaluating you as you work.

But as the week has gone on, I think we’ve started to find our rhythm and develop a better understanding of how to work together. There’s something rewarding about that process—figuring out when to speak up, when to adapt, and ultimately how to become a better team.

And then there are the numbers.

There are 1,002 general surgery cases booked for the next 11 months while the ship is in Ghana. After this first week, there are now 986.

I suggested that we should get a whiteboard and put it somewhere in the OR so we could keep a running countdown of the cases remaining. I was told that would be “too depressing.” 😂

But honestly, I think it would be pretty cool. To watch that number slowly tick downward, knowing that every number represents a person who has been helped—and knowing that you played a small part in making that progress happen.

Since Henry Asked!! My Accommodations

I definitely lucked out with my accommodations! I was given a couple’s cabin, which means—best of all—NO ROOMMATE!!! 😂 I even have both a microwave and a fridge, so I really can’t complain.

It may not have all the bells and whistles of a true cruise ship, but it’s a nice, simple, clean room, and honestly, that’s all I need. I’m on Deck 6, with the hospital wards down on Deck 4 and the operating rooms on Deck 3. That makes this officially the shortest commute to work I’ve had since my call days in residency, when we lived in the hospital! 

The best part is the view. My room looks out over the Gulf of Guinea. Unfortunately, I’m not allowed to take photos of the port, but I can still enjoy the view from my window. I look out over one of the piers, and beyond it is the Gulf stretching toward the horizon, with boats anchored in the distance, waiting their turn to offload at the port.

There’s something pretty surreal about waking up, looking out the window, and realizing that this is my view for the time being. 🌍🌊🚢

Two Hierarchies, One Sterile Field

Going through orientation these last few days and finally starting work, I’ve realized just how unusual my current situation really is.  I have somehow managed to become both a member of a ship’s crew and a hospital employee.

Today, as a crew member, I had to sign the Captain’s Articles. A captain’s fundamental responsibility is to accept absolute responsibility and accountability for the safety and well-being of everyone on board and to be a good steward of the ship and its crew.  By signing the Articles, I have placed myself under Captain Perez’s protection—both on the ship and ashore.  In return, I have promised to be sober, industrious, and obedient to the captain’s orders.

On the bridge

Then there is my other role: surgeon.

And in that role, I return to the familiar world of hospital hierarchy. Even as a surgeon, it can sometimes feel like you’re at the bottom of the organizational totem pole. There’s a Chief Medical Officer, OR managers, outpatient managers, head nurses for every unit ... And then there are the people who actually run the operating room.

If you Google “Who is in charge in an operating room?” AI Overview will confidently tell you that the surgeon is the overall leader and person in charge of the surgical procedure and operating room.  I can assure you that anyone who has actually spent time in an OR knows better.  I’ve always thought the true bosses of an operating room are the scrub nurses and surgical techs.

They prepare the room. They set up the instruments. They know exactly where everything is. They hand me instruments before I realize I need them and anticipate my next move. They keep the circulating nurse informed about what is needed. And they have a sixth sense for anything that threatens the sterile field.

They may be smiling.  They may even be pleasant.  But do not cross their sterile field.

Do not touch their back table.  Do not move something on the Mayo stand.  And for the love of everything sterile, do not reach across their setup because you think you can just grab something.  Because there is a wrath that exists in every operating room on Earth. 😂

Everyone on the Global Mercy is a volunteer and is here because we share the same goal—to use our skills to help people who desperately need it. And I have to say that my new hospital bosses have been exceptionally pleasant to work with.

But after two days in the OR, I have learned one thing for certain:

The wrath of the scrub nurse is exactly the same on land as it is on a ship.  Some things apparently transcend geography, job titles, organizational charts, and even oceans.

I may answer to Captain Perez on the ship...

But in the OR?  I answer to the scrub nurse.

And honestly, I’m perfectly happy to keep it that way. 😄⚓️🩺

Heading to my first day in the operating room.

There are a few things I expected when I came to work aboard the Global Mercy. An operating room on a ship was certainly one of them. 

An influenza outbreak was not. We are currently wearing masks everywhere on the ship because Influenza A has decided to make an appearance. Nothing quite says “welcome aboard” like spending your first days on a hospital ship wearing a mask everywhere you go, wondering whether the person walking toward you is a crew member waiting to cough on you. 

Still, the ship is running, the patients are waiting, and today I finally get to do what I came here to do. My first day in the OR.  Today I get to learn how the OR works on the Global Mercy. The sea is rolling, the masks are on, and somewhere nearby a scrub nurse is undoubtedly preparing a sterile field that I had better not touch. I suspect I am about to learn that some things about surgery are universal—and some things are considerably more interesting when the hospital floats. ⚓️🩺 Here I go.

And It Begins!

Today was our first General Surgery evaluation day.

My co-surgeon and I spent the day evaluating the first 36 general surgery patients who will undergo surgery here on the Mercy Ship in Ghana over the next two weeks. Mostly men with large inguinal hernias, along with a few nice-sized fatty tumors called lipomas.

The patient selection process is fascinating. A team has been in-country for the past several months working with the Ghanaian Ministry of Health to identify regions of the country where access to medical care is limited, so that patient selection could be concentrated in those areas. Clinics were then established in those regions to find and evaluate patients.

The Global Mercy will be serving Ghana for the next 11 months, and all of the patients have actually already been selected. When it is their time for surgery, they are called and asked to come to the ship. If they live a long distance away, they come and stay at the Hope Center. Basically, it is the Mercy Ships version of the Ronald McDonald House. Patients stay there free of charge until their surgery, and then return there after discharge until their first postoperative visit.

And when they come to the ship, it isn't all about the surgery they are getting. An extensive medical workup is performed—probably the first comprehensive medical evaluation many of them have ever had.

They see a medical doctor and have blood work done. They are evaluated by the dental team, and any dental work they need is completed before surgery. Older men with hernias have prostate exams and further workups if any abnormalities are found.

It is really encouraging to see such a holistic approach to surgery. After all of that is completed, and they are deemed medically fit for surgery, they finally end up in the surgeon's office—and we book them.

Tomorrow, we will perform the first four inguinal hernia repairs of this service rotation in Ghana.

Everyone is very excited. After months of preparing the ship, the surgeries are finally starting, and it is pretty special to be part of it.

Mercy Ships has not been in Ghana in more than 20 years, so it isn't really a known organization here. There are understandably a lot of rumors circulating in the country about the purpose of the ship. The worst is that it is a ship full of white people who are here to harvest organs.

To combat those rumors and fears, there has been a major public-relations effort, including inviting members of the press and media aboard the ship to see firsthand what we are doing.

But as things finally get underway, I have to give a lot of credit to the four men sitting on the deck four ward tonight, waiting for surgery tomorrow.

It takes some courage to walk up the gangplank onto this massive, unfamiliar ship and put your trust in a group of strangers to perform surgery on you.

Hopefully everything will go well tomorrow. Hopefully they will have a positive experience. And hopefully they will be the first four men to return to their communities and tell only good things about the Mercy Ships.

Tomorrow is a big day.

Built to Heal

Global Mercy

The idea behind Mercy Ships is both simple and incredibly powerful: if modern hospital ships can sail to places where people lack access to safe, affordable medical care, then the care can come to them.

Mercy Ships was founded on the belief that approximately 50% of the world’s population lives within 100 miles of a coast. Today, an estimated 5 billion people worldwide lack access to safe surgery. The Mercy Ships bring specialized surgical care directly to communities that need it, with ships filled with state-of-the-art medical equipment and staffed by volunteer doctors, nurses, medical professionals, technicians, teachers, physical therapists, and countless others—all driven by a desire to serve and make the world a healthier place.

Don Stephens founded Mercy Ships in 1978 with the purchase of the Anastasis, where he and his family actually lived for ten years. During his time as President, Don led thousands of professional volunteers from more than 60 nations, along with employees working in offices around the world.

The Mercy Ships fleet has changed over the years, and today there are two hospital ships in service: the Global Mercy and the Africa Mercy.

I’ll be serving aboard the Global Mercy.

The Global Mercy entered service in 2022 and is the first purpose-built hospital ship in the Mercy Ships fleet. It more than doubled the organization’s surgical capacity. The purpose-designed hospital decks are really the heart of the ship, with six operating theaters, hospital wards capable of caring for 200 patients, a laboratory, general outpatient, ophthalmology, and dental clinics.

And this is no small ship! While in port, the Global Mercy can accommodate up to 950 people, including 641 volunteer crew members. It also has first-class training facilities, allowing Mercy Ships volunteers to help provide sustainable training and support for local healthcare professionals in essential surgical and related skills.

The Global Mercy arrived in Ghana on August 19th and welcomed its first patient aboard on September 7th.

I’ll be one of the first general surgeons to arrive during this mission, working alongside two other general surgeons. I’m really looking forward to meeting them—and the rest of the OR team—over the next few days.

My first clinic is scheduled for September 14th, with surgery to follow shortly thereafter.

So, for the next couple of days, I have a feeling my primary job is going to be figuring out how to get around this enormous ship without getting hopelessly lost.

Wish me luck! 🚢⚕️

Crew on arrival in Ghana

A new Ghanian Adventure Begins!!

Many years ago, I learned about the Mercy Ships organization and the free specialty surgical care they provide to underserved communities in Africa. It has always been a dream of mine to serve on one of the ships, but because of their volunteer requirements—and my pesky full-time job—it was never really a reality. Until now!

One of the benefits of locums medicine is being able to choose your assignments and work locations, which has finally given me the opportunity to volunteer on the Mercy Ship for a month.

I’ll be leaving for Ghana on September 11th to begin my month aboard the ship. I’m incredibly excited, but at the same time, I’m very nervous about the whole experience. I’ve completed the online training, which somehow managed to create more questions than answers. But at some point, you just have to jump in with both feet, hope for the best, and figure things out one day at a time.

I’m nervous about being completely stir-crazy living on a ship. Will the other volunteers be nice? Is the food going to be horrible? And perhaps most importantly…who will be my roommate?!

What I do know is surgery.

And that gives me some comfort. No matter what new things I encounter on the ship, the surgeries themselves are the same ones I’ve been doing throughout my career—whether that’s in St. Louis, at my new locums assignment in Farmington, Missouri, my future job in Alton, Illinois, at BMC in northern Ghana, or floating somewhere on a ship.

Surgery is surgery.

Operating rooms, for the most part, are the same. A table, lights, an anesthesia machine, and instruments are all you really need for a successful operation—although my training in northern Ghana might challenge the premise that you need all of those things, all at once!

In the end, it’s simply the surgeon, the patient, and the OR staff coming together in a unique situation to hopefully change a patient’s life for the better.

I know that. I can do that.

So as I look forward to this adventure, I keep reminding myself: if I hate everything else about this experience, I LOVE surgery. And in the end, the patients and I will just have to come out on top.

When I first applied to Mercy Ships more than a year ago, I didn’t intend to serve in Ghana. At the time, the Global Mercy was in Sierra Leone and the Africa Mercy was in Madagascar. But as fate would have it, the Global Mercy arrived in Ghana on August 19th to begin an eleven-month period of service to the country.

Although I was initially disappointed that I wouldn’t get to visit and experience another country, honestly, this feels right.

I know and understand the culture, which I think will make adapting to everything else a little easier. It will also give me the opportunity to travel to the Baptist Medical Centre in Nalerigu for a few weeks after I leave the ship—which I am, of course, super excited about.

Over the next six weeks, I hope to share some of the adventures, challenges, surprises, and experiences from my time aboard the Global Mercy and up at BMC.

I hope you’ll enjoy coming along for the ride!