The Search for Potential Surgical Patients for Madagascar 2024 has Started 
Surgical Patient Registration in twelve cities around Madagascar:  Antananarivo, Toamasina, Vavatenina, Brickaville, Amparafaravola, Miarinarivo, Itasy, Ambilobe, Sofia; Melaky, Ihorombe, and Fitovinany.   
All on the same dates: 11 – 29 March on Mondays, Tuesdays, Thursdays, and Fridays = 12 days.  As I shared in my last update that since I returned in August 2023, I made promises to people to provide them with the necessary information, which I did through WhatsApp, Messenger, Email, text, and in person. 
Yesterday I had the opportunity to join the patient selection team working here in the port city.  Our day started at 1:30 am at the largest hospital.  One of their team members is my friend, and his neighbor is a tuk-tuk driver, and so we had transport to get there.  When we arrived, we found more than 200 people under the palm trees on the beach.  I joined my friend at the main entrance, handing out tickets to potential patients (my favorite location during the larger mass screenings Mercy Ships did in the past).  Then I switched over to the pre-screening – primarily just holding up a flashlight and umbrella as it continued to rain.  It was at this location the potential surgical patients shared details on their need for surgery.  Once we got the people inside the building, I helped with crowd control and getting people to the right locations.  I greeted each of them with a smile and the greeting here of: “Salama” and with the older ones, “Salama Tompoko,” which is more respectful.  Some wanted to hear more of my Malagasy language – I shared all I knew, and some laughed, but that’s fine with me.  With the young ones, I would demonstrate the fist bump and then see if they would fist bump with me – success with all except for one little guy who started to cry.  Parents brought their children needing surgery, including unilateral (one side of the lip) 

and bilateral (both sides of the lip) cleft lips, two sweet little girls with cleft palates, a boy with severely bowed legs whose papa was with him.  They both have the same look and amazing smile.  Many others came with facial tumors.  

Photo Caption:  Surgical Patient Selection Poster – try and see if you understand the Malagasy language.  
One aspect that is new to me is that this same team handles selection for all surgical patients —including ophthalmic (eye) surgeries. In previous seasons of Mercy Ships, the Eye Team made their own selection separately. So yesterday, we had a good number of older people blind from cataracts, and getting them from station to station takes a bit more, though most all came with a caregiver. 
I have really missed being a part of the patient selection process. 
Still while in Liberia in 2022, I was invited and was on the patient selection team in Senegal and for the planning for patient selection in The Gambia.  While I was the Country Director in Liberia, we already began discussing how we would reach out for surgical patient selection to 15 counties of Liberia.    

I found great joy in being a part of this activity and found myself smiling. 
Since August, all that I have been doing in getting containers with medical and non medical supplies cleared through customs, arrangements for the hospital ship at the port and all the required services, and some with immigration for our incoming volunteers, is for patients in Madagascar so they may receive the hope and healing.   Please pray as the team continues – they have eight more days in 12 locations around Madagascar.  

May we continue to Love God and Love and Serve Others. 

KRB Update 2268 Arrival of the Africa Mercy in Madagascar Keith Robert Brinkman                                    04 February 2024  Photo Caption:  The Africa Mercy arriving in Toamasina, Madagascar on this past Thursday – 01 February  Photo Caption:  Arrival Day with our Country Director, Esperant Mulumba Photo Caption:  The day before the arrival of the Africa Mercy.  I told the officials I would not leave until all the other vessels at our location had been moved. Short 34 second video available on Facebook  Thankful for the smooth transition for the immigration process and arrival day formalities.    Prayer Requests:  *Smooth Activities with customs clearance of our incoming containers   *Plus for our Patient Selection Team as they work with the Ministry of Public Health for the dozen sites around the country to identify surgical patients.

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Keith Brinkman

c/o Mercy Ships P.O. Box 2020
Lindale, TX 75771

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“The Mercy Ship is returning to Madagascar” 
Ever since I arrived in Madagascar in early August after leaving Liberia in July, many people have expressed their great excitement that the hospital ship is returning.  The Africa Mercy will arrive on 01 February for a ten-month field service. 

So, I have been on the ships most of the times when one of the Mercy Ships vessels arrives into a country.  Though, I have also been on land to welcome the ship and that is exciting also. 
In the Malagasy language, ‘Welcome’ = ‘Tonga Soa’ – so in between coordinating with the ship technical teams and our shipping agent and our partners of the Port of Toamasina, I will be welcoming the Africa Mercy with Tonga Soa.

As Port Liaison here in Madagascar, I have been working with the port officials related to the berth for the ship – same berth as 2014-2016 – use of the same warehouse as before but it needs some repairs, confirmations on the fresh water, arrangements for fuel deliveries, garbage removal and other activities. 
Plus learning the process for how Customs Clearance will take place for our incoming shipping containers and air freight – the paperwork and the required signatures needed from the capital and then the process here in the port city.  The ship relies heavily on incoming supplies, medications, food, equipment, and parts via containers.   

Prayer Requests:  *For the ship’s safe journey from East London, South Africa to Toamasina Madagascar, *Safe docking of the vessel, *Smooth Activities with customs and immigration.  *For the Mercy Ship team interviewing potential local workers, that they would have clarity on who is the best to serve with us and in what positions. *Plus for our Patient Selection Team as they work with the Ministry of Public Health for the dozen sites around the country to identify surgical patients.  May we continue to Love God and Love and Serve Others. 

PS – This a fulfilling time as the Global Mercy is in Freetown, Sierra Leone – providing specialized surgeries and education/training for healthcare professionals in Sierra Leone.  Our last visit to Sierra Leone was in 2011 and was one of my favorite field services – connection with patients – visit to their homes.  

Photo Caption:  Enjoyable Visit with my friend and former local worker, Pierrot. While serving on the ship, our local workers (day crew) and patients were the ones I got to know the best.  Here in Madagascar, I have been reuniting with many of these and making new contacts also.

Photo Caption:  Connecting with new friends from a friend’s church – who want to serve with the ship as day crew.

PS – a note on Liberia – after the second round of elections, they have voted for a new President – the former Vice President will now be the President for the six year term – Mr. Joseph Boakai.  We know him from the previous visits to Liberia from 2005 – 2008. 
On the sad side, after Christmas in Liberia there was a tanker explosion and over 50 people died and over 90 to the hospital due to burns and their injuries.  

Misaotra, Veloma, Tonga Soa, Salama, Fitahiana, Azafady – are all examples of words in the Malagasy language.  Malagasy is the national language of Madagascar.  The other official language is French, though it is considered to be the language of the colonizers.  Wikipedia tells us that Malagasy is the westernmost Malayo-Polynesian language brought to the island in or around the 5th century AD.  There are some words in common with the African continent                                                                     
Bantu languages and some Arabic expressions were brought here by the traders.  Around 25 million people speak Malagasy.  There are some major dialects from the Western Coast, Central, and Eastern Coast – I am living in and calling Toamasina ‘home’, so on the Eastern Coast.  However, I am trying to learn phrases in the standard language and not get involved with dialects.  When you try to speak some Malagasy, the people appreciate the efforts as they know their language is only spoken here vs. French, English, Espanol, etc.  Not many know English, but some will know some phrases as there are tourists who come through this area.  Malagasy is a beautiful-sounding language, I especially enjoy hearing it in praise and worship when I visit local churches.  I came prior to the ship in 2014 and was here for almost 2 years, so now I am enjoying reconnecting with people here – thankful for Messenger and WhatsApp and friends who know our other friends and have helped me reconnect.    
The Christian population here are Catholics (brought to the country by French missionaries in the 19th century), Presbyterians, Anglicans, Lutherans, and the ‘new’ churches – like the Baptist, Assembly of God, Pentecostal, and others.  The proportion of Muslims is small, though there is a mosque near our team apartment, so I hear the calls for prayer.  Often, when I visit a church on a Sunday morning, I am given the opportunity to share briefly on Mercy Ships.  When I ask ‘how many remember the Africa Mercy in 2014 – 2016′ many of the hands are raised.  I share a bit about the ship’s return in 2024 and that maybe they would know someone who would know someone who needs healing with one of the surgeries we can provide on the ship.  Plus for those here in the port city if they know of ones who may wish to serve with us as local workers (day crew) and to pray for us as we make the preparations.      

Photo Caption:  Visited a friend’s church – she was day crew in 2014 – 2016 with our hospital chaplaincy team and wishes to rejoin in 2024.
Last week, I was invited to a meeting of the Federation of Church Leaders for the area of Toamasina.  The Federation is primarily the ‘new’ churches.
I was given time to share about our plans to return, how the Body of Christ in Toamasina can be involved with referring surgical patients, identifying locals who would be able to join and serve with us, and for God’s will.  During the meeting, one of the pastors shared part of his testimony on how he received eye surgery on the Anastasis when the ship was in Madagascar in 1996 and how he gave his heart to Jesus and is now serving as a pastor today.  Two others shared how they had been local workers also back in 1996 and are now pastors.  I left the meeting with my heart so full of blessing and wishing to share with the Mercy Shippers from that time that their labor of love and sharing the two hands of the gospel have impacted people here and they are impacting others.   

Serving together,

PS.  Last weekend, I had my third birthday in Madagascar (2014, 2015, 2023) – a  celebration over the weekend – dinner out with friends, a home-cooked meal with a missionary family, day off, and visited First Love Church – as I was walking the last kilometer to the church, they were playing ‘Goodness of God’ song in French and this part of the chorus is so true <And all my life, You have been faithful.  And all my life You have been so so good>.   

The above is in Malagasy, the language of Madagascar, where I am currently serving.  I figured out the translation of ‘Jesus Christ’ but was unsure about the other two words – a friend shared the translation:  “Jesus Christ is the Center”  Amen.

I spent two Christmases in Madagascar in 2014 and 2015, but those were Christmases with the Africa Mercy and all the fantastic opportunities available onboard the hospital ship.  This year, I celebrate Christmas ‘on land’ in Madagascar. 

I received an invitation from a local ministry here where their children and teens shared the Story of Jesus’ birth and served the community children lunch and gave them a gift.  Till today, which was their Christmas celebration, the staff and I served them as they performed the drama of the birth of Jesus and time of singing and dancing and eating rice, zebu (beef), and carrots and receiving their gift.  
Christmas Eve, a group of us Mercy Shippers will attend a friend’s church for their Christmas program – available in Malagasy and English.  Then, on Monday, Christmas Day, I will join a missionary family here in the area.  I wish all of you a special Christmas season, wherever you may be.   
 

Here are links for two Christmas songs you may recognize but probably have not heard in this language.  

Hobiana – Feliz Navidad  – fun video with pom poms at a party

O Holy Night – sung in Malagasy – lyrics in English – this same church has a congregation near Toamasina, which I visited.  
 

Merry Christmas

Dear friends and family,

SALAMA – a greeting in Madagascar of hello, good morning, good day, good afternoon, and even good evening – so a great word to know often here.

As mentioned in my last update, we closed down Mercy Ships activities in Liberia, I have moved over to serve on the team in Madagascar.

Some of you may remember Mercy Ships served in Madagascar for almost two years (2014 – 2016) when the Ebola disease was in Liberia, Sierra Leone, and Guinea, West Africa.  I went ahead of the ship and served on the assessment/advance teams there.

In my new role as Port Liaison for Mercy Ships Africa Service Center, I am in Madagascar and am focusing on the arrangements for the ship in the port (I will share more details later), the customs and immigration arrangements which can be a challenge due to the uniqueness of Mercy Ships and our agreements with the host nation’s government, and any other arrangements and activities needed for the team.  Last week, I hosted a team from our Marine Operations department, and so we spent many hours at the Port.  In our big meeting <see first photo>, the port officials remember Mercy Ships, though some of them were in different positions than what they have currently.  The Port Director is the same man as before, and he remembers me from 2014.  They are encouraged to work with us once again.

For Madagascar, I am living in the port city of Toamasina (also known in French as Tamatave) – Mercy Ships has two Team Apartments in the same building.  Apartments with two bedrooms, an open living and kitchen area, and a covered balcony.  The apartment I am in, its balcony looks to the south, but not high enough above the trees to see the port and the ocean.  In the Southern Hemisphere, it is winter, so the temperatures are pleasant now – currently with high temperatures averaging around 80 degrees F (26 degrees C).  

    Photos:  part of the Port of Toamasina and a Group Photo after the Initial Survey

I flew into the capital, Antananarivo which is located in the middle of the country at a higher elevation. I will return to the capital for higher-level government meetings as needed.  Though the journey was difficult when Mercy Ships was here from 2014 – 2016 via the road, it is worse now than then and takes much longer.  The Country Director and Operations Director for Mercy Ships in Madagascar are living in the capital with their families.  Other Mercy Ships team members will join us here in Tamatave.  

The Africa Mercy‘s upcoming field service is scheduled for February 1 to December 14, 2024.  The Africa Mercy is undergoing some major renovation projects in Durban, Kwa-Zulu Natal, South Africa (where I spent most of 2010) and will also be in East London – soon to be known as KuGompo in the Eastern Cape, South Africa, and then will travel to Madagascar.

I feel great reconnecting with former local workers, crew, and partners here in town, walking the streets, attending Sunday church service, and visiting the restaurants, barber shop, and grocery and local markets – re-establishing myself now in Madagascar.  I will be sharing more with you about Madagascar and Mercy Ships plans in this beautiful country through these KRB Updates.

As the firstborn son, my Malagasy name is Lahimatao – abbreviated to ‘Lahi’ – so that is the name I use here.

Serving together,

Dear friends and family,
As the outgoing Country Director assigned to Liberia, I wish to celebrate what has happened. Still, only some of what has happened in Liberia can go into this update about Liberia.  I have said my goodbyes to Liberia and the dear people I call friends there with the phrase shared with me from a senior Mercy Ships leader ‘for the time being.’    

Liberia had anticipated hosting the Global Mercy in Monrovia. However, we shared with the Minister of Health in Dakar, Senegal last year in May that a ship deployment would not be possible for various reasons.  In late May of this year, we shared with the same Minister of Health that all of Mercy Ships activities would finish by the end of June 2023.  Mercy Ships wishes to focus more on the countries where the ships will be visiting in the upcoming years.  A meeting followed and even with disappointment, the Minister was thankful and keenly interested in all that was still to take place, especially the strategic donation of eight more anesthesia systems for her hospitals and the user training.    

With this update, I wish to celebrate what has happened and rejoice with this phrase from the hymn ‘To God be the Glory, Great Things He hath done.’ 
I have a heart full of gratitude for the opportunity to be a part of this for the past 33 months of my life. 
The below was also shared with the Minister for her to share with the President George Weah.

Photo Caption:  Final Day of Training – User on the Diamedica Glostavent Anesthesia System at a hospital in Monrovia (I am in the background on the right-hand side)

Mercy Ships Key Achievements 2021 – 2023

Based on assessment visits, the Surgical Care System Needs in Liberia Workshop held in May 2021, and in partnership with the Ministry of Health, Mercy Ships came alongside the healthcare system in Liberia in the following areas:

• Training & Strategic Donations
  • Anesthesia:
    • 24 Diamedica Glostavent Anesthesia Systems with Patient Monitors donated and user training provided for 15 hospitals in 10 counties of Liberia.
    • Anesthesia Training – SAFE Obstetric Anesthesia Courses and Anesthesia Provider Mentoring in two hospitals.
  • Biomedical:
    • Two Training Courses for all Liberian Biomedical Technicians in 2021 – Mentoring conducted in all 15 counties.
    • Equipping the Workshop at the Healthcare Technology Management Unit at the Ministry of Health. Continuous support to biomedical technicians on various equipment.
  • Leadership Development Training & Mentoring
    • Four Hospitals over Two Years – Jackson F. Doe, JJ Dossen, Redemption, and Emirates hospitals.
  • Training Courses
    • Safe Surgery, Neonatal Resuscitation, Primary Trauma Care, Nurses, Nutritional Agriculture, and Mental Health.

                      = 685 training participants in 2022 + 335 training participants in 2023

• Nurse Assessment Kits
  • 3,002 nurses and midwives in all 15 counties received the kit to assist them in caring for their patients at their facilities.
• Donations: 40’ container of PPE, portable oxygen concentrators during Covid, new blue scrubs, 70 Nursing Drug Handbooks, face masks, exam gloves, audiovisual equipment, notebook computers, 120 new hospital beds, and other items
• Surgeries: 216 head and neck surgeries were provided free of charge for 208 Liberians, with Mercy Ships personnel at a partner hospital and mentoring simultaneously.
   

Some kind responses are posted below – they were received after notifying our friends and partners about our departure as I wanted them to hear from me about the closing of our activities and not for people to hear via rumors in the market, workplace, church, or mosque. 

• From Professor Robert M. Kpoto: “Mercy Ships during your tenure have done remarkably very well in Liberia.  It’s sad that Mercy Ships have to end all activities in Liberia.  I pray that in the not too distant future Mercy Ships will return to Liberia because the country and people of Liberia really need the critical humanitarian services they provide.”
   
• From Dr. Ponnie Robertslee Dolo, Medical Director “We are sincerely humbled by your dedication and commitment to helping improve healthcare in Liberia. May your next assignment be fruitful. Thank you from all of us here at the Jackson F Doe Hospital.”
   
• From Dr. Wiyatta Diggs, Physician Anesthesia Provider, shared over WhatsApp, “Mercy Ships have always been there for the people of Liberia. You’ve made a lot of sacrifices ensuring safe health care delivery. You’ve conducted workshops, trainings, and immense donations. Look around the entire country and see how many Glostavent Anesthesia System machines have been donated for safe surgeries.”

Photo Caption:  Convoy of Four Vehicles from Liberia picked up at the border with Sierra Leone and on the road to Freetown for use by the teams there and the soon arrival of the Global Mercy into Sierra Leone in three weeks.

We genuinely hope that with the strategic donations of anesthesia equipment and training, there is now better anesthesia in Liberia and, thus, safer surgery for the population.

I want to thank all the Mercy Shippers worldwide who have participated in what has occurred in Liberia.  From those who came to conduct the trainings, organize the trainings, purchased the specific equipment needed for the healthcare professionals here, shipped 40’ containers with donations. 
Huge thanks to all my friends, family, and church for your prayers and financial support, and encouragement.   

So many good seeds of hope and healing my Team and I have sown in faith in Liberia.

To God Be the Glory

So ‘for the time being’, bye bye to Liberia,

Keith “Kofa” R. Brinkman

PS – I will continue to serve full-time with Mercy Ships with the Africa Service Center on the Country Engagement Teams, next opportunity as Port Liaison, heading to Madagascar in just over a week – more to follow in my next KRB Update.   

Photo Caption:  Day of Departure with Yahyah, who has been on the team since 2021 and ensured that I got to the airport safely.  It may look like I am traveling light, but that is not true. I already checked in my luggage and Mercy Ships luggage at the airline’s office in the city the day before. 

Greetings from Liberia as we are in the dry season now so it is hot here and in the political season as major elections will take place in October of this year. 

Way back in May 2021 at our Surgical Care System Needs in Liberia workshop, we learned of the great need in the areas of leadership, biomedical, anesthesia, and supply chain.  So, we have endeavored to help the Liberian healthcare system in three of the areas (only not able to help with the supply chain).

In my last update, I mentioned how Mercy Ships is donating new anesthesia equipment that has been engineered for environments as we find in Liberia with on and off electricity which you can’t time or anticipate.  The electricity (here we say ‘current’) may go off in the middle of a surgery and unsure if it will turn back on or if the backup system at the hospital will work.  This new anesthesia equipment has a battery backup and can continue with all features for 30 minutes and even longer with just ventilation and no oxygen concentrator use.  In your role/position, you have the training but if you don’t have the equipment to do your role, it is limiting and frustrating and that is the case with some of the anesthesia providers in Liberia.      

We never want to donate medical equipment without the user’s training on that particular machine.  Those using the anesthesia equipment are nurse anesthetists.  For the user training, I decided I would travel with the trainer from Diamedica, the manufacturer in the United Kingdom.  I learned that Jon has been to almost 30 countries but this is his first time in Liberia.  He is a designer, engineer, and trainer on their equipment.  By traveling with him, I was able to connect with hospital leadership who I have known since the workshop but have not been able to visit in their hospitals in the interior.  Due to the road conditions and the amount of time it would take to get to the hospitals, for two hospitals, we used Mission Aviation Fellowship (MAF) – less than a two-hour flight from the capital.  Amazing to see the country with the dense forests and rivers from the air at about 8,000 feet.   

Fifty-six Liberian healthcare workers serving in hospitals where Mercy Ships donated the Diamedica Glostavent Anesthesia Systems and Patient Monitors with CO2 received in-person excellent user training by the manufacturer’s designer/engineer/trainer.  The equipment donation and the user training are steps towards better anesthesia and safer surgery in Liberia.  I am currently working on another donation of eight anesthesia systems.   

This last Sunday, I joined one of my former patients at his church, still within Monrovia, but a bit more isolated in its location.  I had shared briefly at the church previously and this time the pastor gave me the same opportunity.  Though instead of the news about the ship coming and how they could help us find potential surgical patients from the villages, I shared the sad news that the ship is not coming to Liberia.  I didn’t give many details but shared what we have been doing and what we have planned for the next few months.  I reminded them and myself about how our lives and our futures are in the hands of God. 

The church has two choirs – one choir is ladies, and they sing in the Kissi language and I just clap if I can stay on the beat as I don’t understand anything.  The young people’s choir sings in English and the song they had prepared – the chorus goes like this ‘No matter what comes my way, my life is in Your hands’.  Almost exactly the same as the encouragement I shared with them ten minutes early. 

I love how God is like that. 

Serving together, Kofa Keith  (at this church, I go by ‘Sahr‘ – firstborn son of my mother and father.  

Happy New Year to you all.  Here in Liberia – one can continue to wish Happy New Year throughout the month of January.

I have been thinking about 2022 and all that took place and looking forward to 2023.

As Country Director, I am writing my Annual Programmatic Report for 2022, I think of the dozens of Mercy Ships volunteers who came in 2022 to Liberia to serve.  At times I had four teams in the interior and one anesthesia provider here in the capital. 
685 Liberians benefited from one of our trainings here including Biomedical, Obstetric Anesthesia, Safe Surgery, Neonatal Resuscitation, Nurses, Primary Trauma Care, Mental Health, Leadership Development, and Nutritional Agriculture.  A part of the vision is to see a well-organized, efficient, and effective surgical health system in Liberia that has the specialized staff to deliver timely and quality care for patients, staff within the surgical care systems are empowered, increased efficiencies within surgical care facilities, and improved leadership and structural capacity to enable a more responsive surgical care system.
Mercy Ships is in partnership with the Ministry of Health and other partners to see this come about.

In my updates, I often share some Prayer Points – including security, safety, and health for all of our people – as Country Director a prayer I lift to our mighty God regularly.  Liberia is a difficult country in many ways.  I am thankful to God that our teams were safe, secure, and healthy to do what they came to do – to Love and Serve God and Love and Serve the people in all 15 counties of Liberia.
For 2023, I am planning our activities – focusing on some continued trainings and follow-up with past training participants – strategic donations of up to 16 Diamedica Glostavent Helix Anesthesia System <which is an award-winning machine which has its own backup power and portable oxygen concentrator – both are important for a country like Liberia with unreliable power sources> to hospitals in counties around Liberia – see photo.  All of the anesthesia providers at the selected hospitals will receive in-person user training.  Safe anesthesia is so needed for safe surgery.  We have been involved in providing continuing education for almost all of the anesthesia providers in Liberia and have gifted and continue to gift the equipment needed.  In addition, Mercy Ships trained all the biomedical technicians in Liberia.  They received extensive training on this machine and this machine is at the Heatlhcare Technology Management Unit at the Ministry of Health and at the nurse anesthesia school for training purposes.  

After a successful pilot project to come alongside the nurses of Liberia, we have a couple thousand more nurse assessment kits en route to be distributed. 
Though as shared in a previous update there is no ship deployment planned for Liberia due to various complications, we will be closing out activities by mid-2023. 
I am praying about what lies next for me as my passion is to continue to serve with Mercy Ships – where? what position? but I know He is faithful and will continue to be faithful.      

A note about Baby Girl Sangalkam who I shared about having her cleft lip surgery at the Africa Mercy in Dakar, she is at home, doing well.  I have received photos of baby girl from the family and she is adorable.  

The Global Mercy is sailing soon for Dakar, Senegal for her first full field service and then later in the year to Freetown, Sierra Leone till June 2024.
The Africa Mercy will leave soon for Durban, South Africa for refit and renovations before going to Madagascar.

Serving together, Kofa Keith