In September 2021 anaesthetist Nur Lubis became the first UK-based volunteer to attend a medical mission since the start of the Covid-19 pandemic. We sat down with Nur to talk about her experience of working at a mission in these challenging times.
Q: How did you feel during this mission? Was Covid-19 an issue? Was it different than the missions you were used to?
A: I felt really privileged to be the last person who went on a mission before Covid-19 and the first one from the UK volunteer pool to go again now as I’m sure everybody is just waiting to go on a mission. It’s been such a long time. I know people are really enthusiastic about going out again, so I was just super excited. It just reminds me why I do it really.
Q: In terms of Covid-19 protocols, what was the situation like? Was the mission really different than the ones you attended previously, such as the all women’s mission?
A: I think with regards to how we work, we have changed a lot based on Covid-19. That’s not just with the mission, but also how we work in our normal hospital. So in a sense that’s nothing different and nothing unusual. So obviously, the mission was very Covid-19 compliant. We could see that a lot of effort had been made to make it very compliant with the regulations.
We received a document that was very clear beforehand. Then we had detailed briefings from the programme coordinators and the local team about the Covid-19 protocols in place. Obviously, the hospital also has its own additional protocols. We are always the guests in the hospitals wherever we work in, so we also have to comply with their protocols. Essentially, these protocols made everyone feel really safe, from the patients to the family and also the volunteers. Some of the children did find the masks and PPE quite scary so I drew happy faces on the gown.
Operation Smile also have additional volunteer roles, dealing with logistics in terms of the Covid-19 protocols and PPE. They had someone whose job it was to make sure that we have everything that we needed in terms of PPE and also that everyone is compliant with the protocols. In some work areas such as the operating theatres we are used to wearing PPEs but we also had access to them at the hotel so we all felt very safe.
Q: How many patients did you treat?
A: We screened 92 patients and operated on 66. We saw less patients on the screening day, but the team leaders continued screening throughout the week. So patients were coming in, and the team leaders were able to then screen them pretty much every day and put them on the surgical schedule.
The numbers were lower than the usual pre-Covid-19 mission for a combination of factors. It was a new site for Operation Smile Egypt, so the local team still need to gain visibility and raise more awareness about cleft conditions in the area. There was also pre-screening already done in advanced both to optimise patients and to avoid crowding on the screening day. Perhaps some parents were still anxious due to Covid-19.
The nice thing about this mission was that we were able to operate on everybody that needed surgery, so we didn’t have to delay anybody or to turn anybody down because usually we have way too many patients compared to the slots that we have for surgery and some patients have to wait. This is obviously very difficult for the patient and their family so it’s just nice that we didn’t have to do that this time. So I guess that’s an advantage of having a smaller number.
It also means that we were less stressed with being compliant with the Covid-19 protocols and we had the time to get used to them. The local team was very seasoned, as they’ve managed to do some local missions throughout the last year. It was just nice when it’s not so overwhelmingly busy, especially on screening day as patients, guardians and volunteers had to have a Covid-19 lateral flow tests and the patients and their guardians can only come in small groups to the waiting area. All these measures added more time to the screening, but we managed to do everything very smoothly and without time pressure.
Q: How does screening work now? Usually the patients start with medical records and then they are seen by the different specialties (nurses, anaesthetists, surgeons etc.).
A: Operation Smile Egypt organised the pre-screening and they also asked the patients to come at different times. This meant we could do all the processes smoothly and without big crowds. The first step was to attend a Covid-19 screening station, where they were tested (both patient and parent). Only one parent was allowed in the hospital, which was very difficult for some of them. Then we did the usual screening process, but with small numbers as we had just 5 patients at a time, so there wasn’t a big number of people in the waiting area.
Q: What was your favourite memory from this mission?
A: Probably my favourite one was a patient waiting for surgery who was a little bit upset and didn’t want to leave his mum which sometimes can be really emotional. What really touched me was that one of the other patients’ who was around the same age and waiting for his operation, ran to the boy and gave him a couple of toy cars he was playing with just to console him.
I just thought that it was such a kind and selfless thing to do because obviously he himself must be really scared, but at that moment he was able to set aside his own feelings and see that someone else needed comfort. It was a touching moment seeing that act of kindness at the time when he himself was vulnerable. It was just very sweet. It makes you think that children are very innocent aren’t they? These things remind you as an adult that you should be a bit more childlike and be kind to everybody.
Q: Did you do some training to local medical professionals?
A: We supervised and trained the new volunteers so they can become familiar with Operation Smile’s protocols and standards of care as well as having the right skills such as such as performing nerve blocks for analgesia so the patients are comfortable after surgery.
Coincidentally I have met the Palestinian anaesthetist when I was teaching in Ramallah in 2017 so it was lovely to see him again and work together. Speaking to one of the other Palestinian volunteers, I don’t think they get a lot of opportunities training in Palestine. So they really appreciate these chances, especially the surgeons. It can also be difficult for them to get out of Palestine and attend training so they were very enthusiastic. They can bring back the skills to help Palestinian patients with cleft lip and palate.
Q: How was the mission from the patient’s perspective?
A: I think Operation Smile Egypt did a great job with the pre-screening. That makes a huge difference as you identify patients with other conditions (e.g. malnutrition or other diseases) early. You can then do something about them in good time. The mission was also done at a really good time of year, because it was still relatively warm. Sometimes, what we see is patients with chest infections, especially if the weather is a little bit colder. These kids can then infect each other and we unfortunately ended up having to cancel their surgery until they have recovered which usually means the next mission. So it was good that none of that happened this time, which was amazing. I don’t think we had to cancel a single one and we managed to provide surgery to everybody, which is satisfying.
Q: Is there anything else you’d like to share?
A: Donors should know that even during the pandemic, the local teams did a massive job with the patients and many of the care provided such as nutritional support and speech therapy was able to continue safely.
Although there was no international medical mission for a year the headquarters used the time to update and improve processes and systems so that programmes can now run more smoothly.
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