A team of health professionals is touring Donka hospital in Conakry, Guinea, in March when they spot more than a dozen large, greenish masses covering the ground. To the U.S. team members, they look like an art installation; in fact, they are hospital gowns and surgical drapes, laundered and spread out to dry. They are a vivid example of the group’s objective: to lower deadly infection rates caused by unsterile procedures.
This Rotary Foundation vocational training team is the first to serve under Rotary’s partnership with the nonprofit Mercy Ships. Rotary District 7690 in North Carolina, USA, sponsored the team with a packaged grant, part of the new Rotary grant model that launched worldwide 1 July. The team’s five members will train Guinean health professionals at the two national hospitals.
The Africa Mercy, a 500-foot oceangoing hospital ship, is docked in Conakry for a 10-month medical mission. The Mercy Ships staff and visiting experts, such as this team, will tackle a range of tasks, including setting up medical and dental clinics, conducting health screenings, performing surgeries on board, and conducting health care outreach throughout the country. The ship also will serve as a steel-hulled security blanket.
“Mercy Ships looks for ways to continue helping local medical professionals after the ship leaves port, ” says Michelle Bullington, who helped advise the team. “Improving sterilization techniques would have a sustainable impact.”
Rick Snider, former governor of District 7690, worked on a Mercy Ships vessel for five years with his wife, Linda, and coordinated the Guinea project. He recruited assistant governor Jenny Braswell as team leader. A recently retired public health official, Braswell has volunteered on numerous Rotary projects in rural Nicaragua and Jamaica. Her husband, Sherrill, a physician, became Braswell’s first recruit for the Guinea team. She handpicked the rest from among former public health colleagues in North Carolina.
In Guinea, the team’s work begins with a tour of the century-old Ignace Deen Hospital. Laundered gauze bandages droop over railings to dry in the sun for reuse. The well-worn examination tables have no sterile paper, and the medical units are nearly devoid of supplies and equipment such as autoclaves and medical waste boxes. Doctors and nurses provide their own rubber gloves and sterile masks and gowns. Germ-killing bleach is rare.
In the generally clean wards, the patients’ family members sleep under the beds; they are the main caretakers. Food is stored on the floor where it is accessible to vermin, and flies and mosquitoes glide freely through doorways kept open to contend with the heat.
The team also visits Donka hospital, where toilets are flushed with water from a pail, and power outages are common. “The staff members touch patients without gloves, going patient to patient without washing hands. There are unbandaged wounds, flies and roaches, open sewage right outside a patient facility and no sterile barriers, ” says Sherrill Braswell, adding an observation that he later repeats so often it sounds like a campaign slogan: “They are doing the best they can with what they have. ”
For a week, the team provides training in reducing infections, covering topics such as using surgical gloves, masks, and gowns; controlling rats and mosquitoes; disinfecting with bleach; tracking infectious diseases; and hand-washing.
“Fifty percent of hospital-associated infections could be prevented with hand-washing, ” Lyon says. Knowledge gaps soon become apparent. A serious misunderstanding exists about hand sanitizer: that it causes germs to stick to the hands. “It is important to clarify that hand sanitizer kills bacteria ” – particularly in a place where running water is unreliable, Jenny Braswell says. An exchange on wound care illuminates the need to treat wounds immediately to avoid infection instead of waiting until symptoms appear.
Donka’s director, Hadja Fatou Sikhé Camara, says her hospital wants to reduce infection, “but we lack the equipment and supplies. We are willing to do what you do, but as an undeveloped country, we lack the means. ”
When Sherrill Braswell presses for what is needed to reduce infections, the answer is lengthy: more autoclaves, antibiotics, vaccines, bed nets, and rubber gloves, in addition to computers for blood analysis and a water tower to maintain running water. Of six operating rooms, only the new maternity units have UVGI (ultraviolet germicidal irradiation), a standard sterilization method.
After decoding the health system and enduring the non-gridded power, the team accomplishes its objectives, at least according to pre- and post-tests that show significant learning. Positive results also are evident in the participants, who voice a new commitment to educating family caregivers.
Even small changes could have a big impact, the team says. “If they could get patients and caregivers to wash their hands, and if they would hang up the surgical drapes instead of drying them on the ground, significant improvement would result, ” Jenny Braswell observes.
But the lack of supplies and equipment cannot be ignored, she notes. Providing bars of soap would help, as would arranging for inexpensive solar-powered autoclaves for sterilizing surgical instruments.
Back home in North Carolina, the team is continuing its work by trying to acquire and deliver materials the hospitals need. “The hospital workers are able to do the job,” Braswell says. “But they need the supplies. ”
Read the full version of this story in the November 2013 issue of The Rotarian