Ship AFM-BEST hi-resFor 35 years, Mercy Ships has been bringing medical care to areas with dire and immediate needs. The Africa Mercy, pictured, is a floating hospital about the size of the largest destroyer in the US Navy.
By Kurt Woock

Tony Royston does not commute to work. He lives, more or less, at—or above—the hospital where he works. But that isn’t to say that Royston, a biomedical equipment technician, does not get out much. He moves to a different country about once a year. Royston is the technician for Mercy Ships aboard the Africa Mercy, a floating hospital about the size of the largest destroyer in the US Navy. His work commutes to patients.KurtWoockKurt Woock

In 2007, Royston, his wife Patricia, and their son Elliot, moved aboard the Africa Mercy, the same year the ship set sail as a hospital for the first time. When on a mission, between 400 and 450 crew members work to perform reconstructive and general surgery, cataract operations, dental procedures, and orthopedic care, and teach local medical professionals skills that continue to help people after the ship moves on.

Despite the big job, Royston’s office/workspace measures about 8 x 14 feet. There, he oversees equipment in six operating rooms, an ICU, a lab, x-ray, CT, about 80 patient beds in four wards, and two dental facilities. Each Africa Mercy mission lasts about 10 months. Royston has no backup.

Climbing Aboard

For 35 years, Mercy Ships has been bringing medical care to areas where people have “dire and immediate needs.” Mercy Ships, founded in Switzerland, is a faith-based organization. During that time, four ships have visited countries around the world. The volunteer staffs have treated more than 539,000 patients, performed 61,000 operations, and trained more than 35,000 health care teachers and professionals.

Mercy Ships caught the eye of the Roystons in 2006. “My wife and I became convinced that it was time for a change, and we began to look for opportunities to serve in the developing world,” he says. “At the same time that we found out about Mercy Ships online, our church had a couple visit who had served with Mercy Ships for many years, and we had an opportunity to talk to them at length.” The Roystons, who are from the UK, moved aboard once the ship, which had been a rail ferry since 1980, finished a $62 million refit in Newcastle-on-Tyne, England. Signing up for a long-term job that does not come with a paycheck is a risk, and can be costly. Volunteers are responsible for travel fees, immunizations, emergency insurance, and other expenses. Some companies and organizations that crew members came from provide support. Professional scholarships help others. Still others, such as the Roystons, receive support from friends, family, churches, and fundraisers.

For a family, life aboard a ship follows the same routines as life on land. There is a weight room and even a Starbucks onboard. Elliot, 12, attends school at the Academy, the ship’s onboard school, with about 60 other children. The ship’s deck has room to kick around a soccer ball, and, if there’s an open area onshore, he plays ultimate Frisbee.

Every time the Africa Mercy arrives in a new country, Royston must essentially reassemble a working hospital.

For a biomedical technician, the routine is similar to his or her land-bound counterparts, too. “We’re responding to equipment breakdowns, but also user issues,” Royston says. “We have a mixture of long-term and short-term crew. A short-term crew might have never used a particular device before. And, of course, for almost any biomed, wherever you are, it’s not entirely unusual to walk down the hall and have someone run into you and say, ‘Ah! Glad I’ve seen you. Can I ask you a question about such and such?’ That happens a lot.”

Life at sea has its peculiarities, too. Space is always at a premium, and unreliable infrastructures in host countries can lead to spotty external power sources. Patience (as well as onboard generators) help alleviate complications. But, the people aboard might be the place where most of the differences lie. The crew members Royston works with come from 35 different countries. Language is an obvious barrier. Less obvious but equally important is the need to mesh the various medical protocols each member of the diverse staff is accustomed to. “For example, in the UK, an ICU nurse would be expected to provide all the care for their assigned patients, including respiratory support,” Royston says. “In the US, as I understand it, this would normally be done by respiratory specialists who focus only on that aspect of care. Similarly for radiographers (x-ray techs to you); in the UK they would usually be expected to report on the results, whereas in the US that would always be done by a doctor.” Royston says the common goal they share helps overcome the differences.

Working at Sea

Work begins while the ship is in home port, undergoing repairs and maintenance. While there, Royston does preventive maintenance of his own on the medical equipment. “We have a single-slice CT; CR x-ray; C-arm; the usual OR equipment; Mindray, Dash, and Propac patient monitoring; lab equipment for various blood tests and histology; suitably sized medical air compressors; and an oxygen concentrator,” he says. A procurement team at Mercy Ships headquarters is often able to acquire equipment through donations or at greatly reduced prices. “We try to get as much repeatable stuff as possible so we don’t have one piece of equipment made by one manufacturer and another that does the same job but made by someone else,” he says. While on mission, he is able to get parts via shipments, though they occur only once every 6 weeks. Before disembarking, Royston must pack up equipment and secure it in the ship to prevent damage from tossing waves.

FocusOn Tony BIOTECH ROYSTON DB18Tony Royston on board the Africa Mercy, which has a single-slice CT; CR x-ray; C-arm; OR, patient monitoring, and lab equipment; suitably sized medical air compressors; and an oxygen concentrator. While on mission, he is able to get parts via shipments, though they occur only once every 6 weeks.

Mercy Ships has identified a geographic region comprising 17 coastal African countries 15° both north and south of the Equator and 15° both east and west of the Prime Meridian as the overall service window for the Africa Mercy. Most of these countries rank at the bottom of the UN Human Development Index. Mercy Ships receives invitations from the countries it visits and works out a protocol with the government of a host nation in advance of a ship’s visit. An advance team assesses the population’s needs before the ship ever arrives by meeting with the department of health and determining what programs will run in that country.

Every time the Africa Mercy arrives in a new country, Royston must essentially re-assemble a working hospital. The process can take up to 2 weeks. “It’s surprising how many of the things that were packed away aren’t there when you look to get them out again,” he says. “For some mysterious reason, you have a monitor that hasn’t got its EKG cable; all sorts of things like that. In themselves, they’re not very exciting, but it’s significant because if you’ve got a piece of equipment without all the pieces it needs, it might as well not be there.”

Royston does get some help, with equipment cleaning for example, but he is the only technician aboard. There is room aboard for a second technician, but the position is not currently filled. In the UK, it is unusual for one person or even a department to be responsible for all the various equipment in a hospital, according to Royston. However, during his professional lifetime, he has gained experience in most of the equipment types Mercy Ships has onboard. What he did not know, he had to learn. Royston attended university to become a biomedical technician after volunteering at a biomedical facility. In the National Health Service in England, a voluntary register exists that effectively certifies biomedical engineers, but Royston says the registry has been “put on the back burner” in the country.

“Like anyone involved in medical equipment management, patient and user safety is paramount,” he says. To that end, Mercy Ships is currently developing policies and procedures to help keep the standard of care at best practice levels while also keeping in mind the fact that Mercy Ships do not operate in a first-world environment. “The workshop has 115- and 230-volt supplies to power the various equipment we have, although I am slowly changing our equipment to 230 when replacement becomes due to reduce the occasional accident out on the wards,” he says. “There is also a medical gas outlet. As you can imagine, space is premium real estate on board, which often presents challenges!”

Ready to Set Sail?
To learn more about volunteering with Mercy Ships, visit the Web site and click on “volunteer” for more information. Or, e-mail the organization.
For more in-depth information about volunteering with Mercy Ships, a 1-week program is held three to four times per year at the Mercy Ships International Operations Center in East Texas.  
What Does it Take?
Mercy Ships provides opportunities to serve either in a short-term (2 weeks to 2 years) or long-term (minimum 2 years) commitment. Those wishing to serve for more than 9 months must first successfully complete additional long-term orientation programs. Volunteers pay for their own flights and contribute to their room and board on ship during their stay.                                                            

While working on a ship might seem foreign to those who have not spent time on one, the truth is that the Africa Mercy crew is not the group to whom the ship is most unfamiliar. “Most patients have never been inside a hospital—certainly not one looking like a first-world one,” Royston says. “They probably have never experienced air conditioning, rarely met anyone from outside Africa, and actually may never have walked up a gangway or stairs before.”

When the ship is ready, the medical staff conducts public health screenings. “Hundreds, even thousands of people wait in long lines for their chance to see a doctor,” says Diane Rickard, director of international media relations for Mercy Ships. In order to help people who do not live in the port city, physicians and local officials hold screenings inland prior to the ship’s arrival.

More Than a Job

Royston does not draw a salary for what he does. He finds it rewarding in other ways. He says that when patients come aboard, especially patients with significant disfigurements, they hide themselves underneath their blankets. However, during the course of their stay, the staff builds their confidence along with healing their bodies.

Biomedical equipment technicians spend much of their careers behind the scenes. That is not to say their work is secondary or tucked in the background—it is not—but rather that technicians’ work, more so than their physical presence, is what patients see when they receive care. As the only technician, Royston certainly spends much of his time behind the scenes, repairing equipment and teaching others how to operate it, but he also is able to spend time with patients in ways that he has found to be transformative. He says among the most memorable experiences while aboard the Africa Mercy was watching his son play soccer with a boy who had recently undergone operations for bilateral club feet. “Although the young patient wasn’t totally mobile yet,” Royston says, he remembers, “the joy on his face as he was able to do something that he had no doubt wanted but had never been able to do before.”

The Africa Mercy sails within a predetermined square on the globe, far from its home port, because that square contains multitudes of people who do not have access to adequate medical care, the causes of which are innumerable and the consequences of which are no different. The circumstances can be so grim that thinking about the problem in abstract terms—a grid on a globe, a low ranking on a UN list, an estimation of the total number of people affected—can be the only way for some to process it. Rather than keep the problem small by keeping it at a distance, Royston reconciled his life with the problem by choosing to make the problem a smaller, more tangible one, by working in a confined square on a ship, far from home. He and his family give, and they also receive: “In my experience,” he says, “many of the African people have so very little, yet are some the most joyful people I’ve met.” 24×7 December 2012 Focus On

Kurt Woock is the associate editor of 24×7.