The following is an expert from Furthest Peoples First: M2H’s Mission to Teach Through Mobile Surgical Care for Africa’s Sick, Poor, and Remote, a medical autobiography published on October 20, 2020, from Greenleaf Book Group.
Praise for Furthest Peoples First
“In Furthest Peoples First, the enthusiastic and indefatigable Dr. Geelhoed shares the blueprint for humanitarian medical aid done right: tangible, no-strings-attached service to the critically underserved with an eye on the transfer of expertise to indigenous practitioners.”
—Jason Jarvis, CEO, College of Remote and Offshore Medicine Foundation
“This is humanity with humility indeed.”
—Katy Payne, Zoologist and founder of The Elephant Listening Project, Bioacoustics Research Program, Laboratory of Ornithology, Cornell University
Preface
For many of us, access to basic medical and surgical care is often taken for granted, since we have diverse and rich access to it in the United States and other developed countries. However, in the more remote regions of the world, this type of care is still often nonexistent. Because of this, I have spent most of my life working to bring these services to the forgotten people of this world.
Historically, the more advanced nations have pitched in to help prevent the spread of disease by donating vaccines and medications. While this practice treats some of the people who need it, it is limited in scope. It also creates a dependency in the developing nations where such donated services are quickly acclimated within the developing nations’ economies and then still more are demanded, creating a neocolonial dependency within the beneficiaries of these charitable short-term aid programs that become long-term entitlements. Hospitals and clinics donated and erected over time by wealthier nations have been limited to the more populated areas, and people in need located in harder to reach, more remote places have been ignored. And even with these donations, millions of deaths in the most desolate areas of the world can be attributed to a lack of basic surgical care.
In 2014 I founded Mission to Heal (M2H), a Washington, DC–based non- profit to address this dilemma on a global scale. Adhering to our motto of “Furthest Peoples First,” M2H’s goal is to operate on the fringe of what many would consider civilization—in regions that lack electricity, potable water, and proper medical care. Many of these target regions also experience severe drought, poverty, government instability, and civil war.
M2H seeks to bridge the healthcare gap by providing free surgical care to people for whom basic medical care is either scarce or entirely nonexistent, and during this process, we train local practitioners how to continue the healthcare legacy after our volunteers leave. Our model is one that crosses boundaries of culture, national or ethnic identities, and language to share knowledge and deliver sustainable care.
Initially, I treated and taught people in developing countries how to cure and prevent the spread of diseases. And wherever feasible, I brought modern medical and surgical skills to address an array of health issues ranging from spinal Tb osteomyelitis, hernias, and typhoid fever to skull and extremity fractures and Marjolin’s ulcers. I traveled to locations that had existing clinics or hospitals equipped with limited personnel and supplies, or I set up temporary remote base camps, which required transporting personnel and supplies on foot, horseback, boat, vehicle, or aircraft. While these efforts were effective in their own right, I knew we needed to do more if we were to reach people in the most remote regions of the world and to create a truly more sustainable and lasting impact for them after we left.
Beyond needing capital to build hospitals and clinics in remote areas, we also faced the issue of training staff and hoping they would continue to live and work in these regions. For example, once trained, local people are often reluctant to return to the remotest areas, and they seek out a better life in the larger cities. I also noticed that the farther I ventured into remote areas with my hands-on approach, I found few to no resources to rely on. Operating on a patient in the open air or in a tent or a makeshift building with boarded-up windows to keep the flies out is risky, since sterile conditions are a challenge under these circumstances.
When past efforts took us to Ecuador, the Philippines, Afghanistan, Mongolia, Nigeria, South and North Sudan, Eritrea, Somaliland, Congo, Mozambique, Central African Republic, Chad, Liberia, Ghana, and Malawi, we were limited not only to existing clinics with limited resources, but we were also equally limited by the reach of available transportation. I began to discuss an idea with the new M2H board of directors, suggesting the development of mobile surgical units (MSUs) that could navigate the most challenging terrain so we could reach those who were too poor, too sick, or too remote to receive the medical and surgical care they needed. Instead of hoping that the afflicted patients might find their way to an operating room somewhere, we could bring the operating rooms to them.
After sharing my ideas with the board, my next step was to find someone who could build the MSUs at a price that might fit our budget. I decided to work with someone in the private sector who could adapt our prototype more rapidly and at a potentially lower cost than what the local governments (i.e., the mendicant government agencies of the developing world in places such as Nigeria, Congo, and Afghanistan, which often have limited capacity for wise use of these first-world facilities and are universally known for their graft potential), the UN, or multilateral NGO agencies would likely charge. I approached Bliss Mobil in the Netherlands (purveyors of state-of-the-art truck-mounted living spaces) to create MSUs similar to those built by the US military. During our conversations, I conveyed that these mobile operating rooms would need to be able to visit various otherwise unreachable mission destinations with all the needed surgical supplies and equipment on board.
Bliss Mobil’s design team (Marleen Hoex, Eduard Hagen, Gijs van de Looy, and Peter van der Wouw) was phenomenal in creating the prototypes. Soon after, plans were laid out for two fixed operating tables to simulate our mobile surgical gurneys, with space around them to conduct operations and accommodate all the necessary ancillary equipment while allowing for maintaining sterile working conditions in often unfriendly environments.
We specified that these self-contained operating rooms should be able to be transported by truck, train, ship, or plane. It was also important that each MSU be comprised of two sea container–sized modules, and along with the two operating tables, have solar- and diesel-generated power, HVAC and water purification systems, a shower and toilet, a food prep area, and staff sleeping quarters.
The designers helped identify the best type of carrier vehicle for this purpose: the MAN KAT, which met all our specifications of size, choice, and cost. The MAN KAT also held one huge advantage over any other options: It was already a major supplier of this type of vehicle to developing countries. Since the designers were used to working with MAN KATs, we deemed them the supplier of choice.
It was exhilarating to see years of planning come to fruition in 2017 when the MSU-II modules A and B were created. My dream of bringing advanced surgery and medical services to the poorest and remotest people on the planet was about to be realized! I was honored by the Republic of Ghana, the Queen Mother, and by Auntie Anna with a chieftain’s title on January 19, 2017.2 The honors and privileges the title brought (free passage between and into the nations of Africa’s commonwealth and the respect and recognition of royal personages from Ghana’s fellow African nations) made gaining an audience in front of Africa’s indigenous organizations increasingly more possible. As Fred Graham-Yooll so aptly stated in my last book, Ebenezer, “What better and more secure source of funds could there be than funding by Africans themselves? And what could be better than if they were asking for the support directly? . . . Just imagine African organizations working together to bring the miracle of modern medicine to all their countries with making life longer, more rewarding, and pleasant.”
I was inspired to write Furthest Peoples First not only to share our latest mission work in Africa (which was part of a joint medical and educational project of M2H and local partners in the various countries we worked in that took place from January through November of 2019), but also to inspire and invite others to join us on upcoming missions. For decades I have carried out these trips on my own. And now, after creating M2H, a nonprofit global medical missions agency, I am ready to institutionalize this work so it will continue sustainably with future generations.
In this book we will follow M2H’s 2019 transects of Africa with two of our MSUs in which we provided medical and surgical care to the people of Somaliland, Ethiopia, Kenya, and Uganda. Our mission had three purposes: 1) to heal patients, 2) to train local health professionals to indigenize care, and 3) to offer medical students, surgical residents, and volunteers the opportunity for a transformational learning experience by participating in a medical mission in Africa.
During the African transects, local health workers, clinical officers (COs), and midwives were trained to task by the M2H team and African Diaspora doctors. These healthcare professionals were also updated on current health policies and objectives. I led the transects and traveled with 14 volunteers, 87 team members, and two MSUs. During our missions, we performed over 800 surgical procedures in four countries with the assistance of the state-of-the-art MSUs. These “mobile miracle machines” with multiterrain capabilities helped make medical treatment more accessible throughout the transects.
These latest missions are the start of a larger plan: M2H plans to return to these remote areas in subsequent transects to continue to raise the level of healthcare there. We also plan to expand our reach by placing more MSUs in various regions of Africa and other parts of the world.
Thank you for taking this journey with me. As you will see in the pages ahead, each day of our missions is an adventure in healing, perseverance, patience, compassion, and flexibility. Despite the best-laid plans, we were often tasked to surrender them to allow for something even greater to manifest in their place. I am grateful to the amazing team at M2H and to all of our supporters. Because of you, our work can continue to reach the furthest peoples first for generations to come.
Glenn W. Geelhoed, MD, AB, BS, DTMH, MA, MPH, MA, MPhil, ScD, EdD, FACS Derwood, MD,