Why I Scan: Dr Raymond’s Story of the Mercy Ship

Times of crisis remind us about the importance of access to medical care and how many in the world lack that access even in the best of times. This is a story of Canadian radiologist, Dr Greg Raymond, and many other medical professionals that use their training to help those in need across the world on Mercy Ships.

^{Dr Raymond and his mother. “My Mom set a great example of selfless service and kindness for me and my siblings”}

Mercy Ships is an international humanitarian organization that operates state-of -the-art hospital ships to deliver free, world-class healthcare services to some of the world’s poorest nations. Every year over 1200 volunteers from up to 40 nations donate their time and skills onboard the Africa Mercy. The Africa Mercy is a converted ferry and is the world’s largest civilian hospital ship that moves around sub-Saharan Africa, porting for 10-month intervals in areas of great need. She is currently stationed in the Republic of Senegal, ranked 164 out of 189 countries on the UN Human Development Index, where access to healthcare is extremely limited. The population of Senegal is approximately 14.7 million people and there are only 7 physicians per 100,000 people. In Canada, we are privileged compared to the billions of people living in poverty with very little or no healthcare, so this concept can be difficult to comprehend.

Canada has a long-standing history with Mercy Ships with various professionals donating their time on board the ship. Canada has also developed programs to enhance recovery and sustainability once the ship departs, with programs such as the Hospital Out-Patient Extension (HOPE) Centre, Sterility Processing training program and Hospital Chaplaincy program.

Mercy Ships also has a unique partnership within the Canadian Radiology community out of Edmonton, Alberta. A group of Radiologists from Medical Imaging Consultants (MIC) donate their time to read X-rays, CT and, on occasion, ultrasounds for the Africa Mercy. They report back to the ship and collaborate with physicians to achieve the best possible outcomes for their patients.

A native of Nova Scotia, Dr Greg Raymond trained at Acadia and Dalhousie Universities. He was a medical officer in the Canadian Armed Forces for 20 years. During his time with the Armed Forces he was trained as a flight surgeon and was the base surgeon at CFB Comox. He was also a diving medical officer and served overseas in the Middle East and Golan Heights. While working in the military he did extra work as an emergency room physician in civilian hospitals. He eventually became the Chief of Radiology for the Canadian Armed Forces and served in that capacity for many years. He was full-time military until 2005, during his time with the military he maintained his skills working with Medical Imaging Consultants, where he has now been for more than 20 years.

Dr. Raymond is passionate and dedicated to the work with Mercy Ships and it resonates as he shares his journey and reflects on some of his experiences. “I became aware that Mercy Ships was in desperate need of radiologist support in 2007 when I received an email from the Christian Medical and Dental Association asking for radiologists to help Mercy Ships. I had always wanted to do medical mission work and having spent 20 years in the Canadian Armed Forces as a physician, I had travelled to many foreign countries where medical care was suboptimal or worse.

For the first few years, I did most of the cases on my own with some help from radiologists in Great Britain and Australia. With some difficulty, I would download cases from the Mercy Ships archive onto my home computer, unzip the cases, review them, and type up a report to send back to the ship. Over time, I slowly recruited other Medical Imaging Consultants (MIC) radiologists to help, particularly in sub specialized areas such as pediatrics and neuroradiology. I also involved radiology residents in the work, many of them eventually became my colleagues, and are now major contributors to the radiologist services provided to the ship.

In 2014, the MIC partnership voted unanimously to provide full imaging coverage for Mercy Ships pro bono. This was a tremendous day for me and for the rest of my life I will be grateful to my partners for this commitment.

With MIC‘s official involvement, our IT department worked with the IT department on board Mercy. A very sophisticated and streamlined approach was established to load all their imaging cases on to our RIS-PACS, and using a secure system with the reports automatically emailed back to the ship. Over the past few years, we have done many thousands of cases including X-rays and CT examinations primarily and on occasion, interpret ultrasound examinations as well.

I distinctly remember the first case that I reported for Mercy Ships, it was on a seven-year-old girl named Brandi who had a huge mass growing out of the side of her face. She lived in a West African country that had virtually no healthcare and without the assistance of Mercy Ships she would certainly not have survived. Clinically, they suspected the lesion was inoperable however on the CT assessment I was quite certain that it was not invading any essential structures and it had a fairly benign or low-grade appearance. Subsequently, I was able to provide a roadmap for the surgeon and the lesion was successfully removed. Postoperatively she did very well and has had no recurrence over several years.

I learned very quickly that most of the patients had very advanced disease, either large tumours that had been growing for many years, or end-stage infections such as advanced tuberculosis or HIV. There were also many severe congenital deformities, poorly healed fractures and trauma related injuries, in addition to orthopedic deformity secondary to nutritional deficiencies. Additionally, almost all of the patients had very poor dental health and I’ve seen numerous complications related to advanced dental infections.

As a radiologist our principal role is to determine whether the case is operable or inoperable and if operable, to provide a detailed assessment of anatomy related to the tumour or malignancy and providing the surgeon with a roadmap. This is a huge responsibility and if the case is inoperable or there is obvious metastatic disease, it is with great sadness that I realize the patient will not be cured. However, Mercy Ships will do their best to provide palliative care and pain control in those instances.

^{Left: Pre-operative axial CT image, Right: Pre-operative coronal CT image}

^{As his way of gratitude, Sambany has given his consent to Mercy Ships and all affiliates, permission to share his story and images to teach the world of the lifesaving treatments he received.}

Another case that stands out in my mind from a few years ago relates to a middle-aged man from Madagascar called Sambany. He had a gigantic mass growing out of the side of his head and neck, the lesion 2-3 times larger than his head. He was near death, emaciated, and an outcast because of his appearance. He heard of Mercy Ships, at that time docked elsewhere in Madagascar and sold all his worldly possessions to pay to have 4 men carry him for several days to the ship.

On reading his CT it appeared that there was a possibility it could be resected successfully although the surgery would be extremely complicated. Dr. Gary Parker, the chief surgeon and chief medical officer of Mercy Ships, decided to go ahead and attempt the surgery. The surgery lasted 14 hours but was successful! To see the joy and gratitude of Sambany after he recovered was profoundly rewarding!