Circa 2011
Orthopedic surgeon Johannes Bernbeck, MD, occasionally leaves his spinal surgery practice in Southern California to travel the world with Mercy Ships, an organization that has been bringing global charity to developing nations since 1978. When the Mercy Ship docks at ports in Africa and the Caribbean, patients come aboard for critical operations they might not otherwise receive. Bernbeck spoke with ABILITY’s Tom Chappell, MD, and publisher Chet Cooper about how he and a team of volunteers work on a floating hospital.
Chet Cooper: How did you get involved with Mercy Ships?
Dr. Johannes Bernbeck: I first hooked up with Children of the Nations through my church. It’s a non-governmental organization that cares for children who are orphaned and destitute. I wanted to get a taste for providing medical services in underserved parts of the world. Then I aligned myself with Mercy Ships because I wanted to get in with a group that’s already gone through its growing pains. Mercy Ships is a well-functioning organization. I’m learning more about the logistics of how it’s run.
Cooper: I’m amazed by all the work you do locally at Kaiser Permanente, in addition to the work you do overseas. You’re about to take another trip now.
Bernbeck: That’s right. Children of the Nations is based in Africa, but I’ve also traveled with that organization to the Dominican Republic. I joined up right after the Haitian earthquake. Things were in such disarray in Haiti that I thought it would be better to work out of the Dominican Republic. The two nations share one body of land.
Cooper: How was that experience?
Bernbeck: Eye-opening. Children of the Nations has a clinic in Barahona, the poorest part of the Dominican Republic. Once a year, a big team of doctors—mostly from the northwest—bring their equipment and perform operations. But when the staff leaves, they take their equipment with them. The rest of the year that clinic is empty.
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I’m trying to get equipment donated or purchased so the clinic can stay open permanently, and so that we can have a constant presence. There are plenty of doctors who would love to go there for a week each year. If I can get 52 doctors to each spend one week in Barahona, we’ll have year-round staffing.
Cooper: How is that undertaking coming together?
Bernbeck: We just got some x-ray equipment donated, so we’re working out the logistics of getting it into the country without having to pay high tariffs. We’re going to inventory our surgical equipment on this trip, so we can solicit more donors to fill whatever gaps we have. We hope that a year from now we can start doing more procedures and help more people in the region.
Cooper: When you’re on the search for equipment, are you looking for contributions from the manufacturer, used equipment, or what?
Bernbeck: We have a variety of sources. If a hospital has equipment that’s obsolete but still in good condition, it may be fine for use in procedures in a developing country. Hospitals can make a tax-deductible donation of equipment that they would typically just put in storage. We believe it’s good for a hospital’s “brand,” or for the brand of any other entity, to donate to an organization like ours.
Cooper: All the equipment stays on the ship, right?
Bernbeck: Right. The hospital’s on the ship, and all the equipment stays there, too. I’m trying to learn how they run things, because it’s analogous, to some degree, to this hospital in the Dominican Republic, which I want to get up and running.
Cooper: How many Mercy Ships are there?
Bernbeck: There used to be several, but now there’s only one. Hopefully in the future they’ll have additional ships, but right now it’s just the Africa Mercy. In the past, Mercy Ships had vessels that went down to South America as well.
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Cooper: What happened to those?
Bernbeck: I think some of them were getting so old that they weren’t worth the cost of the maintenance. Every year, when the ship goes into dry-dock, certain systems need to be rebuilt and brought up to speed. It costs hundreds of thousands of dollars a year just to keep a ship functional.
Chappell: Are these Navy ships?
Bernbeck: The ships come from a variety of sources. The one I served on, Africa Mercy, was previously a rail ferry. I believe it had been used to transport locomotives and rail cars across the North and Baltic Seas. A rail ferry has a big open space, making it ideal for a hospital ship. The inside of the ship is built like a hangar, so not much needs to be torn out to convert it into a hospital ship. If you were to convert a cruise ship, you’d have to tear out a lot of things.
The downside is that when a rail ferry crosses the ocean, it rocks a lot. This is not your typical ocean-going vessel with a deep V-hull. It has a flat bottom, which makes for a rougher ride. We sometimes have to hold on to the xray equipment, and to the back table where the sterile supplies are kept, so nothing rolls around.
Cooper: Did you keep any kind of notes or diary when you were on the ship?
Bernbeck: I sent a lot of e-mails to friends back home. There were so many impressions, so many different things that happened, and a lot of emotions. People walked into our hospital from all over Sierra Leone. Some of them walked for three or four days when they heard a hospital ship was there. They would carry their children and stand in long lines to see us. At one point there was a big fight and a man died. Eleven people were trampled. These people were so desperate to get medical attention.
Cooper: Incredible.
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Bernbeck: People had been prescreened before we’d gotten to Africa. They were organized into categories of need. We were there as orthopedic surgeons, so all of the orthopedic cases were presented to us. We met with 40 of those patients for a secondary screening, so we could personally examine them, see what their problems were, and assess what equipment was available to do the procedures. We had to be realistic about what we could do. We didn’t want to get into the middle of a procedure we didn’t have the equipment to finish.
Cooper: That sounds a little overwhelming.
Bernbeck: There were more patients than we could help. There was a man—I’ll never forget him—who carried his son for two or three days to get to us. The man’s son had a chronic bone infection. The injury was to the leg, which was also broken, and the skin was disrupted. But we weren’t equipped to handle it, because that sort of thing requires a lot of repetitive procedures, and usually months of care. And even after treatment, that boy would need pretty sophisticated antibiotics that we didn’t have. That region didn’t have very many antibiotics to choose from. So we basically had to turn this man and his son away. The father had such hope, and he’d come so far to get care for his son.
Chappell: So basically it’s triage that you’re doing?
Bernbeck: It is. You have to tell some people, “Sorry. We don’t have what it’s going to take to fix your problem.”
They have incredible mortality rates in Sierra Leone. One of eight women dies in childbirth. One of five children dies before age five. So it’s a very sad experience, being there. They have something like two doctors per 100,000 people, and are considered one of the five most underdeveloped countries in the world. That’s why Mercy Ships chose that country, because there was a need, and it was safe enough to go in and provide care.
Cooper: How often does the ship go to Africa?
Bernbeck: Mercy Ships has a constant presence in Africa. I think it arrives there in March, spends 10 or 11 months at one port, and then goes somewhere to be drydocked and refurbished. Whatever needs to be done will be done during the dry-dock phase, and then the ship goes somewhere else.
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Early next year the ship will be back in dry-dock, getting fixed up again, and then it will go to Guinea and spend the better part of a year there. I’ll be spending a month, probably March, on the ship while it’s in Guinea.
Chappell: You perform only spinal surgery in your practice at Kaiser Permanente Medical Center. I imagine when you were out on the ship, you had to sharpen your general skills?
Bernbeck: Right. Most of what we were doing there was pediatrics: straightening out leg deformities and treating neglected traumas. We harvested a lot of bone grafts for that work, so my skills in that area came in handy. The other orthopods over there hadn’t harvested bone grafts in years, and I used to harvest a lot of it. That came pretty naturally to me, thanks to my basic training. But, yeah, you have to get out of your comfort zone a bit and do things you don’t do at home.
Cooper: Is there any follow-up?
Bernbeck: There is. I’ve been in touch via email, finding out how my patients are doing. They keep a physician assistant there, and they have an orthopedic surgeon who provides follow-up. Then, when the ship sails, one doctor stays behind. Long-term follow-up is done at a hospitality clinic there.
Chappell: There are so many things we take for granted in our lush medical system.
Bernbeck: Yes. The basics we enjoy just aren’t there. A hospital ship makes perfect sense for regions like those, because on a hospital ship you don’t have to worry about the country’s electricity or water supply.
Chappell: What kind of equipment is at your disposal?
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Bernbeck: The ship has an x-ray tech and a pretty limited lab, and you do your pathology via satellite. You take a pathology slide, put it in a microscope, get on the satellite, send the images back home, and you have a pathologist, stateside, who does the reading for you.
We don’t store blood. If someone needs a blood transfusion, we find someone on board with the correct blood type and get the blood fresh. We get the crew members who match a certain blood type to form a line, and then blood is drawn and given to patients.
Chappell: A blood bank on a boat would be really hard to manage.
Bernbeck: Right. This is all fresh, whole blood. In our time there, we didn’t have a situation in which we had to give a blood transfusion. But we did have a power outage during one of our surgeries that resulted in pitch darkness. The ventilator for anesthesia even turned off. We performed surgery with a flashlight until the backup power came on.
Cooper: The ship has a dependable power supply?
Bernbeck: It has a main generator, as well as a smaller backup generator that provides emergency power to the intensive-care unit and the operating room.
When the power went out during that surgery, it was an incredible experience. The patient had come in once before with a femoral fracture. He’d been hobbling around with his leg flailing about because his femur hadn’t healed. We were not allowed to do any femoral rodding, but I knew we had access to tibial rods. We formed a little committee and talked about the problem, and I told the team, “You’ve got to trust me. I know we can do this. I know the guy will do well. We’re here to help people.”
Now, I had a tibial-nailing system that I’d never used before, and I was using it for a purpose for which it was not intended. In fact, I was doing a technique I’d only read about, and I was doing it in a foreign country, on a hospital ship, where I didn’t have half the equipment I needed. When the power went out, I was operating by feel, trying to get a femoral nail into a shaft. But in the end, it all went well.
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Cooper: That must have been a shock—performing surgery when everything went black.
Bernbeck: I felt as though God was in there helping me the whole time. He had me there for a reason.
You’re going to have certain things that are not under your control, and you just have to trust that they’re going to go well in the end. And, as it turned out, this surgery did. The patient did fantastically well. I heard later he was walking on the repaired leg. It’ll take a few months before it gets a solid union, but probably a month or so from now I expect him to be healed.
Cooper: Did you find any religious conflicts in the region? Any resistance to your medical services as a Christian organization?
Bernbeck: I saw the opposite, actually. We had Muslims and a Jewish guy in our group. In fact, all different religions were serving. Mercy Ships is mostly a Christian organization, but we’re open to anyone.
We would also pray quite a bit with our patients. Even if you asked Muslim patients, “Would it be all right with you to pray in the name of Jesus?” They’d say, “Fine, yeah, I can use all the help I can get.” I was pleasantly surprised by how friendly and open-minded people were.
Chappell: Have you been doing this sort of work for a long time?
Bernbeck: I just started doing this about two years ago, but I’m hooked. I love it. It’s given my life great purpose. I’m now trying to engage my family in this mission, too. In a few weeks I’ll be taking my son to the Dominican Republic and Haiti. I think it’s important for him to visit those places and understand just how lucky we are. We shouldn’t take for granted what a great country we live in.
Chappell: What are the language barriers you confronted during your work?
Bernbeck: The language spoken in Sierra Leone is called Krio. It’s basically a Creole form of the English language. When it’s slowed down, I can get it. They might say something like, “Me gladdy,” which means, “I’m happy.”
Chappell: Are interpreters available?
Bernbeck: Yes. Locals are hired to do various tasks on the ship, including interpreting.
Cooper: Do doctors have to pay their own way on these excursions?
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Bernbeck: We had to pay for the flight to get there. We had to pay crew fees on the ship, too. Each day we’re there, we pay a certain amount of money that covers our room and food.
We also do our own cleaning. There is no cabin service. The cafeteria does have a kitchen staff, but the ship is completely run by volunteers. Even the captain is a volunteer. He’s been doing this job for five years, and the whole enterprise is funded by donations.
Chappell: What about equipment failures? In this country, when something breaks, you just go down the hall and replace it. But if you’re on a boat—
Bernbeck: We fly in a technician to fix the broken equipment and have a new part shipped in. The technician will probably be with us for a week before he’s able to figure out what needs to be done and how to actually fix the problem. You do what you have to do.
Cooper: You must be acutely aware, while doing work like this, of all of the cultural and economic differences between the United States and some of these other countries. It must give you a great sense of perspective.
Bernbeck: Re-entry to the United States was difficult. The work I do here is meaningful, but at an entirely different level. In the United States, I’m trying to restore function and take away people’s back pain. I’m taking them from maybe 70 percent or 80 percent functional to 90 percent functional. In Africa, I was taking in people at 0 percent, and they were grateful if I was even able to get them to 50 percent.
