Credit: ©March 13 2004, Mercy Ships International

It's Monday morning at the practice, so what do you have on your list of things to do today? Perhaps a few oral health assessments, disposing of sharps, helping to fit a crown or two or perhaps discussing oral health and hygiene with some of your patients?

Well, just imagine carrying out these everyday tasks on a hospital boat thousands of miles away in a war-torn land. This is exactly what Canadian dental therapist Frieda Schmidt (pictured far right) does on a daily basis since she joined the Mercy Ship M/V Anastasis which is currently docked in Freetown, Sierre Leone.

Credit: ©March 13 2004, Mercy Ships International

Mercy Ships, a global charity now in its 25th year, has operated a growing fleet of hospital ships that travel to developing nations since 1978. The 522-foot flagship, the M/V Anastasis, is currently the world's largest non-governmental hospital ship. She contains three fully equipped operating rooms, a dental clinic, a laboratory, an X-ray unit, and a 1,500 ton cargo capacity.

Founded on a Christian ethos, Mercy Ships provide medical care and community development services to countries in the 'two-thirds world'. It is the only charity in the world to run a fleet of fully equipped hospital ships, enabling it to provide quality healthcare to some of the poorest people across the globe.

The fleet consists of the M/V Caribbean Mercy, the M/V Africa Mercy and the flagship, and Frieda's current home, the M/V Anastasis.

Volunteers like Frieda come from all over the world to work on the ships for periods of anything from two weeks to a year, while others may choose it as their career. With a crew consisting of skilled doctors, surgeons, nurses, teachers, dentists, water engineers and agriculturists, the ships are a very effective way of getting help to those that need it.

'When you consider that 70 per cent of the world's population live within 100km of the ocean, ships are an effective way of getting much needed help into a country,' according to Frieda.

She heard about the work of the charity from her brother who went to join one of the ships in Jamaica to help with rebuilding work after the particularly destructive hurricane Hugo had ravaged the land.

'To start with I joined the crew a few times as a short term volunteer for a period of five weeks at a time. Then I came back the fourth time intending only to stay for five months, and ended up staying three and a half years. After this I went home to Canada for a few years but returned to the ship in 2001.'

The ship recently returned from its last outreach project, three months in Sierre Leone and three months on Togo. 'The surgeries consisted of a lot of head and neck maxillofacial surgery, eye surgeries and a lot of removals of really huge tumours', says Frieda.

Dental clinics are situated off the ships. An advance team goes to the country some months ahead of the ship and chooses a place where a dental clinic will be set up. 'We have portable equipment and we try to set up a five chair dental clinic and work there for the duration of the ships stay in that country, which is usually three and a half months each country or the whole stint in one country, depending on the needs and demands of those we are trying to help. We will be staying in Sierra Leone until May this year.'

Credit: ©March 13 2004, Mercy Ships International

Describing the dental problems that patients present, Frieda describes the danger that untreated symptoms can cause.

'One woman had heard that the ship was in Freetown and come by boat. Her head was swollen from a dental abscess and we removed two teeth. However, her kidneys had already started shutting down from the infection and if she hadn't received the treatment she needed she could well have died from the dental abscess. She was four months pregnant. I knew that people could die from dental abscesses but this time I saw it for real.' In a nation whose annual health expenditure per capita is around 28 US dollars, minor ailments can become fatal and simple operations are deemed too expensive.

'You see a lot of people with basically quite healthy mouths but they have one or two severely decayed teeth and some with rapid decay especially severe periodontal problems. You can see how war disrupts people's lives, pushing them from pillar to post and so brushing their teeth loses priority.'

The dental team aboard the ship usually consists of four dentists, a hygienist and a dental health educator. The team believe it is very important to have a full time educator who goes to schools, clinics, hospitals and into communities to teach oral health.

'If we don't educate people about oral health, they don't understand why oral decay occurs. This means people won't change and we will continue to do band-aid dentistry. That's why we are really trying to push the dental health aspect and have a full time educator.'

To this end, Mercy Ships is working on a project to begin a dental therapy training school in West Africa. 'The school won't train people to become dentists, but to become dental therapists, because a dental therapist can address the main problems such as fillings and extractions, get people out of pain and do education and treatment in schools. This sort of work changes the oral concept that people have of their mouths. We can go on forever doing the clinics, and while that may help many people, the dental health of these countries is not going to change if that's all we do. Our hope is to have the school going by September 2004, and we are starting out with just a few students in the first year studying on a two-year course.'

From November 2003 until May 2004, in addition to the onboard surgeries, the crew will train adults in literacy, empower women in micro-enterprise, cooperate with the Ministry of Education on a child development programme and improve access to potable water for tens of thousands of people.

Frieda finds her role on the ship both satisfying and rewarding. 'The people we help are very grateful. Often they thank us by bringing bags of oranges or a papaya, they can't bring money but just want to give us something to say thank you and that's so rewarding. Our clinics are a very exciting place to be.'

After providing medical care and development assistance in Sierra Leone three years in a row, Mercy Ships is now turning its attention to the West African nation's neighbour, Liberia.

Some of the Mercy Ships crew have been to Monrovia to assess the safety and feasibility of the Anastasis sailing there this autumn.

In the meantime Frieda and the rest of the dental team are set to continue their work in Sierre Leone. She says, 'It's very exciting to work with people who are looking to make such a difference.'

For more information about the work of Mercy Ships or to volunteer, visit www.mercyships.org.