Missions of Mercy

Dec 07, 2017

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Her only option was surgical debridement under general anesthesia. The other option may likely have been slow death from sepsis. Fitia was already malnourished and weak. So I paused.

Nathan Claus

Nathan Claus wears more hats than would seem possible. As screening supervisor with the international global charity Mercy Ships — whose mission is to increase access to health­ care throughout the world — he says his job is "part nurse, part logistician, administrator, case manager, government programs liaison and more."

How did you get started in nursing or decide to become a nurse?

My parents are both in healthcare, but I didn't really become interested in nursing until I first volunteered with Mercy Ships the year after I graduated from high school. We were holding a large screening event in Freetown, Sierra Leone, which several thousand people with medical and surgical problems attended, hoping to be selected for treatment on the ship. The need was overwhelming, and I think a seed was planted in my mind that day that healthcare was a tangible way to meet the needs of those who are suffering.

A few years later I spent two months visiting a hospital in rural India. I spent most of my time with the nursing staff, and I remember coming away from that experience clearly feeling that I wanted to be a nurse. I was moved by their compassion and the amount of time they spent with patients at the bedside as their advocate and caregiver.

How did you become involved in critical care?

Toward the end of nursing school I had a clinical placement in an ICU, and I remember being so impressed by my preceptor. She was highly skilled, knowledgeable, had excellent rapport with the other disciplines, and knew so much about her patients. I saw her strong critical thinking skills in action, and I was drawn to that. It was a very impactful experience. When I finished school I was fortunate enough to get my first nursing job in a burn ICU, giving me the opportunity to develop those honed critical care skills that I had witnessed in my preceptor.

What makes nursing so special?

One of my favorite parts about being a nurse is the flexibility and the variety of experiences you can have; my role with Mercy Ships being a perfect example.

I also love the intimate connection to humanity that nurses have and the opportunity to show kindness to people who are experiencing hardship and adversity. We are often let into patients' and families' lives quicker than normal interactions between strangers. That's a privilege and an honor.

How did you become involved with Mercy Ships?

I was originally introduced to Mercy Ships through a friend and volunteered twice before I was qualified as a nurse. After working in the U.S. for several years as a nurse, I finally was able to return to the ship in a nursing role. I've now been with Mercy Ships on the screening team for most of the last five years.

Volunteering with Mercy Ships is an incredible experience. There are short- and long-term volunteer opportunities for both medically and non-medically trained people. Check out the opportunities at www.mercyships.org/volunteer.

What do you typically do?

I work on the world's largest civilian hospital ship, the Africa Mercy. I lead the team responsible for recruiting and selecting around 1,500 patients who eventually receive surgical inter­ventions on the ship during our 10-month stay in a country. Here in Cameroon this required prescreening over 11,000 potential patients to find those who had operable conditions within the scope of the specific surgeries offered by Mercy Ships. This can be an arduous and sometimes overwhelming process having to say "no" to several thousand individuals. However, there is joy in the process too; getting to accept someone for secondary screening and eventually telling them they have been selected for surgery.

What specifically about this opportunity and the program appeals to you?

One of the things I like most about our work is getting to see fairly quick results from the work we put in. I think we are fortunate in this regard compared to other develop­ment work that is equally important but not as immedi­ately gratifying. It's not that all patients have this immediate transformation once they roll out of the operating room, but many times it truly is a radical change and the difference that it makes to a patient is monumental. Not only are the physical ailments relieved when, for example, a large facial tumor is removed, but the healing process from the shame and stigma that the patient had expe­rienced for years also begins.

There are countless stories like this. Patients come to the ship, scarves covering their deformities, downcast eyes and then leave the ship having not only received much-needed medical care but also emotional healing and a renewed sense of hope.

Can you share a particularly impactful case?

Two years ago, our small team traveled to a city in the northwest of Madagascar called Mahajanga for a screening event. On our final day screening there, one of the last patients to present to us was Fitia, a two-and-a-half year-old who was burned from an accidental scalding in the kitchen. I was the one prescreening patients as they were trickling in late that afternoon. I remember a mother holding a shirtless, frail and scared Fitia in her arms. She stood in front of me just holding her and not speaking. It was that all-too-familiar scene I have witnessed so many times as a nurse working in the devel­oping world - a loving parent thrusting their sick child in my direction with desperation in their eyes.

I had worked in a burn ICU for five years, so I knew what I was looking at, yet at the same time I had never seen anything quite like it. The burn happened five months prior and was massively infected. Fitia was clearly suffering. It's typically not within our scope of practice to accept patients with non-healed burns, let alone ones with large infections. We have been very strict with this policy over the years because of cross-contamination of infections in the ward and limited space and resources to isolate patients.

But that day in Mahajanga I found myself pausing before telling the mother that unfortunately there would be nothing we were able to do to help her daughter. I paused for a long time. I sighed. I held back tears. This burn was beyond giving advice on wound care. There was no possible way that this child was going to let anyone touch her, and without IV pain and sedative medications that would be torture anyway. Her only option was surgical debridement under general anesthesia. The other option may likely have been slow death from sepsis. Fitia was already malnourished and weak. So I paused.

What happened?

Eventually my colleague and I decided to call back to the ship to ask about Fitia's case and see if an exception could be made. The answer was yes. We accepted the patient, and she and her mom flew with us in our 10-seater charter plane back to the ship the next day. Two days later she had her first surgical debridement. The wound began looking so good that she was skin grafted not long after that. Just a few weeks later she was discharged from the ward, once again a healthy, plump child.

A year later, I was fortunate enough to visit Mahajanga again for a screening. To my surprise, I saw Fitia bouncing down the hospital corridor holding her mom's hand. They came to say hello and thank us. They then invited us over to their modest home, and we celebrated Fitia's full recovery over delicious local dishes and orange soda. It was a truly unforgettable experience.

What specific goals do you have for your nursing career?

I'm currently pursuing a Master of Science in Global Health in order to increase my understanding of the health challenges we are facing around the world. I've also had the privilege to be a part of some research studies related to the work we do with Mercy Ships, and I plan to continue with these and hope­fully do more in the future.

It's important to have a healthy work environment and a healthy life outside of work. Is it easy to balance the two?

I wouldn't say it is an easy balance. It's something I am constantly aware of. On the ship we live and work in the same place, so it's fairly easy for work to spill over beyond the "normal" work hours. However, living and working on a hospital ship in Africa is also quite adventurous. We are coastal, of course, so there are usually beaches to visit and other excursions to go on. Our crew comes from over 35 nations around the world, so there are always new and inter­esting people to meet as well.