The hospital opened, ward shifts have started, patients are trickling in and out as we fill a growing number of hospital beds.

This is all so exciting, but there’s something else that deserves attention.

A small team was sent out today to Fenerive Est, a town just north of the port city of Tamatave. Their sole task will be initiating a life-saving training for surgical teams across the country that, if understood and accepted, will literally save lives.

Mercy Ships aims to equip the country we serve. We don’t believe that we are any smarter or talented than the health care providers in this country. All we have is ease of access to opportunities and education.

Imagine being a surgeon that consistently sees poor outcomes. You care for your patients. You want to help them. The gaps in the available resources are numerous. I wonder if they doubt their own abilities and start to think they are second- or third-rate healthcare providers…

We are not here to fix things up, get a pat on the back and an honorable mention and then leave a people behind to deal with the unfortunate circumstances of local healthcare.

Our knowledge and wisdom is not earned by our own merit. We might think so, but the country we were born into plays a big part. In addition, God is the one and only source of wisdom. These local surgeons and doctors are smart, dedicated professionals.

To whom much is given, much is required.

Mercy Ships recognizes this. The Medical Capacity Building department on board is responsible for bringing hope and healing to the nurses, surgeons and doctors of Madagascar. Mercy Ships has a plan to share vital knowledge with regional hospitals across this country.

Something as simple as a checklist and a pulse oximeter.

I hope that wasn’t anticlimactic for you, because this gets me incredibly fired up!

Three years ago I read The Checklist Manifesto (affiliate link) by Atul Gawande. I actually had no idea what it was about. Rather, I thought it was some kind of self-help book. I was looking to enable my addiction to sticky notes and lists. I was familiar with his books and loved them and needed a good read for a coming vacation.

It was one of those books that took my mind into a world I never really considered; the importance of checklists for consistent, safe results.

Gawande used plane crash anecdotes to build his case for the importance of checklists. These disaster stories were perfect reminders of how checklists work well. Air travel is very safe. If you’re thinking about Malaysia MH370 right now, or maybe even 9/11, remember that, truly, much more goes right than wrong. The numbers reflect that. Thousands of flights lift off every morning. These metal tubes glide through the air for hours, and they all land safely at their destination. It’s safe because of a checklist.

A short, simple checklist that can be applied to any aircraft or flight purpose.

Think about commercial construction. When we walk into the mall, we aren’t worried that the ceiling will cave in or the floor will give way. With few exceptions, buildings are constructed well enough that we don’t even think about the structure integrity when we walk in. Here as well we are safe because of checklists implemented in every construction project.

But what about surgery? When someone cuts into your body, there are dozens of things that can go wrong, and in some countries something always goes wrong. Even if the U.S. surgery often comes attached with complications that could have been avoided.

respiratory complications,
extreme blood loss,
performing surgery on the wrong limb or, worse, the wrong patient.

These things happen. Why isn’t there a checklist for surgical care? Why isn’t there a simple net to catch the mistakes of professionals who are very smart, very competent, but simply have too much information swimming in their brain to get it 100% right, 100% of the time?

In the case of low-income countries maybe they have too much despair settled in their heart to see the importance of one detail over another…

The checklist serves as this net.

In The Checklist Manifesto, Gawande gives a compelling argument for the power of a simple surgical checklist to be reviewed at the start and end of each surgical case. He takes it to various countries with variable operating rooms to see if it can be applied universally. It passes the test.

Today The Checklist Team departs for the first stop of a twenty-city tour throughout Madagascar to train regional hospitals on the WHO surgical safety checklist. This checklist, when understood, accepted and properly implemented, can cut operating room deaths and complications in half.

A thorough training, a checklist, and a pulse oximeter will be provided to each regional hospital.

That’s all. This tool empowers surgical teams in any country, especially including low-income countries, with the knowledge that safe surgery is possible.

Mercy Ships cares about bringing hope and healing to the entire healthcare system of Madagascar. We are working ourselves out of a job. Our aim is that one day, these countries will not need us. They will be able to care for themselves through their own systems and structures. They won’t need a big, white ship.

Now, THAT is what we are working toward.


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