A little boy in Africa had a tumor in the roof of his mouth. It blocked his airway, and he struggled to breathe. His family took him to several doctors, but none could help him. He returned home in danger of suffocating.

Then a hospital ship called Africa Mercy arrived, and a fleet of doctors, nurses, and other staff from around the world gradually came on board. Among them was the surgeon who would save the little boy’s life.

Mark Shrime, MD, PhD, treated the child in an operating room aboard the ship. He and his team removed the boy’s tumor and reconstructed his soft palate. Just a few weeks later, he received a photo of the child holding a sign that said, “Hi Mark. I’m all better.”

“That picture is amazing,” Shrime says. It’s a keepsake he’s held onto.

Shrime is the research director of Harvard Medical School’s Program in Global Surgery and Social Change. He’s also a volunteer surgeon for Mercy Ships, a charity that provides free surgeries to countless people in Africa who can’t afford or don’t have access to skilled medical help.

The problem isn’t limited to one continent, though. It’s global.

Conditions that could be treated with operations make up close to one-third of diseases in the world, Shrime says. “And yet 5 billion people around the world can’t get surgery.”

Quality health care for all is the theme of World Health Day on April 7. And it’s a mission for Mercy Ships and other charity groups that make a difference in countries where treatable health problems can turn deadly without surgery.

E.J. Caterson, MD, PhD, is a craniofacial surgeon at Harvard Medical School. He’s also a longtime volunteer with Operation Smile, which treats children born with cleft lip or cleft palate. Some babies with those conditions can have trouble feeding, and in some parts of the world that can bring on malnutrition or starvation.

During one medical mission in Nicaragua, Caterson had to cancel surgery on a child who was running a fever. Operating wouldn’t have been safe. When he broke the news to the child’s mother, he was struck by her reaction: She didn’t look upset.

“She was completely impassive to this information,” Caterson says. “And reflecting on that, the emotions we’re so used to -- joy, despair -- all of those are luxuries when you are trying to survive on a day-to-day basis.”

“And what I realized in that setting was, this is something that we as a developed country, or as Americans, don’t even understand. And it was so powerful to me and it makes me always want to go back and do more, because of the fact that these individuals have no other option in many cases.”

The scarcity of skilled health care in some developing countries poses a grave risk for expectant mothers.

“I think the single biggest issue for women’s health in the world is maternal death in childbirth,” says Andy Norman, MD, an OB/GYN in Nashville and a fistula surgeon for Mercy Ships.

These tragedies happen so often that Norman compares the death toll to several daily plane crashes. But he says media coverage of the problem is almost nonexistent in the U.S. “I’ve never heard any mention about that on the national news, and yet three 777s of women go down every day in childbirth.”

One of the biggest reasons for this crisis is a shortage of blood products for transfusions, he says. Women are bleeding to death during labor and delivery.

Mothers in sub-Saharan Africa are also at risk of losing their babies after prolonged, obstructed labor. “That means that a woman is in labor generally more than 24 hours and the baby’s just a little bit too big to fit through her pelvis,” Norman says. 

It can also cause an injury called a vesicovaginal fistula, a hole that forms between the vagina and bladder. It makes urine leak “all the time, day and night.” And in sub-Saharan Africa, the social consequences for women can be devastating.

“Husbands generally divorce them,” Norman says. Women who return home to their families “are generally made to live in separate quarters so that the house doesn’t smell bad.”

A C-section usually prevents a vesicovaginal fistula, “and that’s why we don’t really see that problem in developed countries,” Norman says. “Almost everybody has access to skilled obstetric care.”

Through his work with Mercy Ships, Norman treats women with fistulas. It’s a “relatively simple operation” that gives them a chance to return to continence and reclaim their lives.

“We perform the surgeries and then take care of the women on an average of 2 weeks after,” he says. “So they really get total care.”

Norman, Caterson, and Shrime all know firsthand what a life-altering difference skilled surgery makes in the places they visit. They only wish more people knew.

“In the discussion of global health as a whole, surgery has to play a larger role than it currently does,” Caterson says.

Shrime agrees, and he offers this perspective: “If you have a lump on the right side of your face that you notice when you were shaving, you would be in a doctor’s office within a week,” Shrime says. But in a place like sub-Saharan Africa, “that’s not feasible.” Suspicious lumps often continue to grow for years.

That’s why Shrime makes the journey to Africa twice a year with Mercy Ships. During these missions, “we operate 5 days a week, and I’m in the operating room every single day.”

It can be tiring work at times. “It’s wonderful, though,” Shrime says.   

Show Sources


Mark Shrime, PhD, research director, Program in Global Surgery and Social Change, Harvard Medical School, Boston; volunteer surgeon, Mercy Ships.

E.J. Caterson, MD, PhD, craniofacial surgeon, Harvard Medical School, Boston; volunteer surgeon, Operation Smile.

Andy Norman, MD, OB/GYN, Nashville, TN; volunteer surgeon, Mercy Ships.

Shrime, M. The Lancet, April 2015.

Alkire, B. The Lancet, June 2015.

Safe Mother: “Vesico-vaginal fistula -- a major cause of unnecessary and avoidable suffering.”

Operation Smile: “About Cleft Lip & Cleft Palate.”

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