A Rare Glimpse Behind the Scenes
July 2010
Jamie Spence, President and Founder
On this web site you can see children’s lives changed and people healed but what does it take to make that happen? Read on for the story never before told.
How can Canvasback provide $1,274,461 in care (Calculated conservatively at Medicare rates) in just one month? How does that value of service translate to a 2,149% return on your investment?
What does it take to empower an ophthalmology team to perform 192 surgeries, with excellent outcomes, giving sight to more than a hundred blind people in just two weeks? Contrast that with a team from another developed nation that performed fourteen but experienced four bad outcomes.
The major reasons for this are the power of volunteerism and the grace of God.
The number one reason is God’s grace. If one crucial part is missing in the shipment we send ahead of the team, the team could be rendered ineffective. In 24 years that has never happened but no one is that good. It’s only by the grace of God!
Second are the relationships of trust and the partnerships formed over 24 years with the Island leaders and health care providers. It is through teaming with them in the preparation and execution stages that outcomes are maximized.
Third are the skills, experience, dedication and hard work involved in the incredibly complex logistics required to recruit, mobilize and support these teams. We don’t organize these trips like a once a year outreach from a church or hospital. This is what we do and what we are trained and equipped to do month after month, year after year.
Let’s look at the January – February, 2010 five overlapping teams to Ebeye Island as an example; ophthalmology, dentistry, orthopedics, cardiology and radiology. There are economies in multiple teams because the same logistic costs can support multiple teams. And remember, the very next month we do it all over again for five teams to Yap Island. The logistics of preparation have to overlap.
The January-February teams provided $1,274,461 in care calculated at Medicare rates. By dividing the out of pocket cost for sending the teams ($59,300) into the value the doctors produced we get a return on investment of 2,149%. No, that is not a misplaced decimal. It is two thousand one hundred and forty nine percent ROI.
Let me give you a snapshot of what makes this high efficiency possible. It stems from the organization required to recruit and support these teams:
First we recruited physicians, dentists and support staff. Each surgery team consists of about 10 missionaries. Non surgical specialties may consist of as little as two health care professionals. To be more cost effective, these small specialties were combined with the larger surgery team. Of course we applied for their medical licenses in the country where they will serve so that they can practice legally. Then we contracted with the republic’s Attorney General to indemnify our doctors and protect them against liability. It’s despicable that paper must come before patients but that is the world that we live in.
A biomedical equipment technician is recruited for each surgery team to set up our equipment and insure that it operates properly. When he is not working on Canvasback’s equipment, he is repairing the island hospital’s malfunctioning medical equipment and training their maintenance technicians.
Then we scheduled with the island hospital and arranged for the local health care providers to triage the patients for us. Pre-screened patients were lined up for surgery when we arrived.
The Ministry of Health got the word out months in advance to the Outer Islands on the AM radio so that outer islanders were able to get a ride in on the field trip micro ship. Then we made travel arrangements for each person on the team and purchased airline tickets from where they live to Kwajalein Atoll in the Republic of the Marshall Islands. They flew on 3 airplanes and rode a ferry to get to Ebeye Island.
With the help of the physicians we secured donations of much of the necessary medical supplies and equipment, including a $50,000 X-ray to donate to the Ebeye Hospital. For the balance of the medical items, funds were raised and the items were purchased. Non perishable foods for the team members were purchased and packed. Every step was important, right down to designing and printing the T-shirts. When everything needed was assembled in the Canvasback warehouse, we crated it in large washing machine sized wooden crates and then screwed down the lids.
For some teams, Drug Enforcement Agency permits were required to carry controlled substances. Our rescue drugs, Canvasback’s defibrillator and crash kit were packed. If a medical crisis should occur, we did not wish to rely on the hospital’s emergency rescue capability.
We also crated all of the operating room equipment needed for each specialty, the Phaco machines, lasers, operating microscopes and auto-refractor. A bill of Lading with an accurate inventory was created and clearance with U.S. Customs was acquired so that the equipment could be re-imported into the United States. Insurance was acquired for expensive medical devices.
Next, a big rig pulling an empty sea container backed up to our warehouse dock and we fork lifted the crates into the sea container until it was filled to the top. We put our combination lock on the container and then emailed the combination to our contacts on Kwajalein. The big rig delivered the container to the Port of Oakland where the port’s giant cranes loaded our container onto a Matson Line ship.
The Matson ship crossed 5000 nautical miles of Pacific Ocean direct to her first port of call, Majuro Atoll. After delivering her containerized cargo in Majuro, she departed Majuro Lagoon through the East Pass and sailed for Kwajalein Atoll where she entered the 70 mile long lagoon and docked at the Kwajalein Army Base. There her ship’s crane lowered our ocean container onto the Kwaj dock.
Our contacts on Kwaj removed the wooden crates from the ocean container and loaded them onto an Army barge which transported them across the atoll’s lagoon to Ebeye Island. Our contacts on Ebeye loaded them by muscle power into a little Kia pickup. The wooden crates were driven two at a time to the small Ebeye Hospital where they were off loaded by hand and stacked in the foyer.
When the Canvasback doctors arrived to unpack the crates, nothing was wasted. The lumber and plywood from the crates quickly disappeared for use in home improvement projects.
Everything that would not fit into the container or was not ready to ship was carried by team members in maximum airline size boxes as baggage. To reduce excess baggage costs, many team members carry one small carry-on of personal effects and two big boxes of supplies. A team of 30 can allow us to carry 60 big boxes.
As soon as the Ebeye container pulled away from the Canvasback warehouse we began crating supplies for the March, 2010 Yap trip. Five medical teams, orthopedics, dentistry, pediatrics, internal medicine and family practice plus a collegiate youth team. Thirty missionaries are on Yap Island with me at the time of this writing.
Continental Air Micronesia occasionally fails to off-load baggage at the proper destination so we plaster the boxes that the doctors check as baggage with red stickers lettered URGENT MEDICAL SUPPLIES, EBEYE HOSPITAL. After that we rely on reason number one. Remember? God’s grace! Every shipment is a miracle.
That’s the story in a coconut shell of the logistics of people ships and crates but what enables Canvasback teams to be so productive once they arrive? Actually, most of the answers to that question are in the story above – organization, logistics, infrastructure and trusting partnerships with the island Ministries of Health.
For example, if an ophthalmology team is to do 192 cataract surgeries, they will have to have lens implants to fit each patient. That means that it is necessary to bring many more than 192. And remember, the Phaco machine and operating microscopes and every piece of medical equipment needed has already been shipped. Add dedicated volunteer health care professionals who are well prepared and supported and all that is left to do is organize the operation in the hospital for maximum effectiveness and patient safety.
The local nurses are taught to quickly prepare the operating room for the next patient while maintaining proper sterile conditions. Remember that the local staff has already lined up the blind patients for us. Final screening is done by a Canvasback doctor who is dedicated to post and pre-op care. His efforts outside of surgery allow the eye surgeons to stay in the operating room and perform the surgeries continuously. The doctor and his staff pray with the patients in pre-op and instruct them in post-op. When we remove their eye patches and they see for the first time in years, it must seem to them like a miracle.
This story did not even touch the many more mundane efforts like housing, feeding and transporting the teams on the island. But you get the point. Just as there is a great woman behind every great man, (My wife insists that I must also say, “And vice versa”) there is a dedicated staff and a complex back story behind every successful Canvasback team.
