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Courageous people travel from all parts of the country, desperate for their condition to be treated – for many, Mercy Ships is their final hope

Rail ferry to surgery ship – building ships of mercy – By Janine Stewart and Shukti Sharma

We usually understand a ship to be a means of transporting people or cargo, a luxury cruise liner or a military vessel. Rarely do we associate a ship with a hospital. In this article, the authors explore the creation and operation of a unique ship, the Africa Mercy (formerly a Danish rail ferry), which operates as a floating hospital, providing healthcare to developing African nations.

In the field of construction, we consider construction and operational challenges on a daily basis. However, it is fascinating to consider how these challenges play out when converting a former Danish rail ferry into a fully operational floating hospital.

Mercy Ships is an international charitable organisation that was founded in 1978 with the aim of delivering free surgical healthcare on floating hospital ships. The Africa Mercy is Mercy Ship’s current flagship and is the world’s largest non-governmental hospital ship operating in Africa.

From rail ferry to hospital ship

Before the Africa Mercy, Mercy Ships operated three ships that served approximately 60 nations across Central America, the Caribbean, and the Pacific. In 1998, Mercy Ships developed a strategic vision to launch a new ship to serve exclusively in Africa, as the need for healthcare in Africa had been assessed as significant and urgent.

Mercy Ships conducted an extensive search on paper and undertook physical inspections of marine vessels that were on the market before acquiring a retired Danish rail ferry in 1999. The Dronning Ingrid was originally built in Elsinore, Denmark, in 1980: she was 152 m long, with a beam of 23.7 m, a draught of 6.0 m, and a gross tonnage of 16,572.

Once the ship had been selected, Mercy Ships invited bids from contractors in the UK who could complete the refurbishment. The firm Cammell Laird was selected. Cammell Laird transformed the Dronning Ingrid into the Africa Mercy, with the finishing work completed by A&P Group in Newcastle-upon-Tyne. Altogether, the  Africa Mercy spent seven years in English shipyards and £30 million was spent on her conversion.

Unique design challenges

Given the intended function of the Africa Mercy, Mercy Ships faced unique design challenges when converting the rail ferry. Long-standing members of the organisation confirm that the most challenging aspect of redesigning the existing ship into a hospital was accommodating a variety of different functions in a finite space.

For example, the hospital covers approximately 1200 sq m of the rail deck and consists of five operating rooms, recovery and intensive care units, and 80 ward beds. The ship also houses a suite of diagnostic services such as CT scanners, X-ray and laboratory services that support the surgical services. Other facilities that augment the healthcare services include satellite communication, which allows the doctors onboard the ship to consult overseas experts, audio-visual technology and air-conditioning systems.

In addition to being a hospital, the ship is also home to a volunteer crew. The Africa Mercy can accommodate an average of 400 volunteer crew members, comprising both individuals and families. The ship also has a school for up to 60 children who stay onboard the ship during the year. It quickly becomes apparent why space was the biggest challenge Mercy Ships encountered when designing the Africa Mercy.


Other design issues

In 2010, another unique design issue appeared in relation to the ship’s engines, as the vessel’s original machinery of six propulsion engines and four auxiliary engines created noise and vibrations that were unsuitable for an operational hospital.

Alpha Ship Design evaluated the engine design of the Africa Mercy and made two recommendations: disconnecting two of the propulsion engines and replacing them with diesel generators, and installing a waste-heat recovery system.

The installation of the new generators involved significant structural and electrical design work. Further, the new generators were placed on a unique foundation. This created a quieter hospital environment by reducing engine noise and vibrations during surgeries.

In addition, the diesel generators save around 1000 litres of fuel per day by running on heavy fuel oil, and the new waste-heat recovery system harnesses the heat created by the engines to meet the crew’s needs for domestic hot water.

When completing the redesign of the ship’s engines in 2010, with the exception of the new diesel generators, all the components for the new machinery were owner-furnished equipment. In an effort to reduce costs while still satisfying the evolving needs of the ship, the machinery components were sourced from Europe and the work itself was completed in Durban, South Africa.

It is important to reduce costs wherever possible because Mercy Ships is a charitable organisation that relies on donations and sponsors to fund its operations. For this reason, the marine operations department of Mercy Ships purchases equipment directly from its list of preferred suppliers to obtain the most competitive market price for equipment, thereby reducing the overall cost of the final built product.

Operational challenges

The operational challenges faced by the hospital ship are quite different to those encountered by standard static hospitals. The Africa Mercy operates by docking at different ports in Africa and providing healthcare services in that local region. One of the common issues the ship encounters is accumulated rubbish in the ports blocking the seawater cooling intakes.

The heat produced by the ship’s engines and machinery is cooled using freshwater which, in turn, is cooled using a seawater cooling system. The Africa Mercy has a volunteer dive team who clear the seawater intakes which ensures that the cooling system runs efficiently to neutralise the heat produced by the engines.

Other operational challenges include compliance and regulatory issues. The crew serving onboard the ship have to comply with and be certified in accordance with the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers 2010 (STCW). The STCW sets the qualification standards for chief engineers plus deck and engineering officers on seagoing ships. Ongoing compliance with the STCW is therefore a necessary part of ensuring the smooth operation of the ship.

The ship itself must also comply with all international regulations pertaining to the operation of a passenger ship. These international regulations span a number of items, such as fire detection and alarm systems, evacuation management, management of emergencies and casualty mitigation. These compliance issues form part of the operational challenges that Mercy Ships must address on an ongoing basis.

Other operational considerations include the maintenance and dry-docking of the ship. The Africa Mercy undergoes an annual maintenance period of approximately six weeks. This allows for the completion of annual surveys and maintenance work that would otherwise interrupt surgeries.

The Africa Mercy has to be dry-docked twice in a five-year period; each time the ship is brought onto dry land to inspect and repair the parts of the ship that are usually submerged. Dry-docking requires a coordinated effort from the ship’s manager, the ship’s flag state, the shipyard and various other contractors and consultants to ensure that the ship passes its dry-docking survey. The ship cannot be used as a hospital during this period.

Delivering hope and healing

Despite the challenges described in this article, the Africa Mercy  remains in service and is currently docked at the port of Douala, Cameroon, in Central Africa, providing life-changing surgery and healthcare to the region.

Mercy Ships is currently involved in the construction of a new purpose-built hospital ship. This new ship will more than double the ability of Mercy Ships to deliver hope and healing, while significantly increasing capacity-building and training potential.

The work of Mercy Ships is always growing and requires the support of trained medical staff, as well as crew with expertise in various aspects of marine engineering to navigate the challenges presented by operating a hospital ship.

Janine Stewart is a partner and Shukti Sharma a solicitor with the 
MinterEllisonRuddWatts full-service law firm; Janine is a trustee on the New Zealand board of Mercy Ships – to follow the story of this inspiring organisation, visit www.mercyships.org.nz

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