New Mercies: Ria Bos
mercy-ships-podcast-new-mercies-episode-88-ria-bos

Director of Patient Selection

Ria Bos grew up in the Netherlands and always had a heart for missions. After becoming an ICU nurse, Ria sought opportunities to use her skills to help those in need — that’s when Mercy Ships came into her story. Now, 10 years later, Ria is still volunteering, currently serving as our Director of Patient Selection. 

In this role, Ria considers herself a bridge with one foot on the ship, working with our doctors and nurses, and the other on land, partnering with the Ministry of Health and local healthcare professionals. Ria loves learning from all the people she interacts with.

In this episode, Ria shares the streamlined way Mercy Ships approves patients for surgery, the hope that is offered each person, and the night she’ll never forget in Madagascar. She also highlights the lasting impact Mercy Ships leaves in our host nations not only through surgery, but through education and training of local healthcare professionals.

Looking for a way to join our mission of bringing hope and healing? Partner with us through a giftvolunteering with us, or by joining us in prayer.

New Mercies Podcast Transcript

Welcome to the New Mercies, a podcast by Mercy Ships, where we’ll take you behind the scenes and on board our incredible hospital ships that are transforming lives all over the world. We invite you to join us each week as we sit down with our crew, patients, volunteers, and partners to hear their stories of life-changing hope and healing.

Ria Bos has one of the most challenging and most interesting jobs with Mercy Ships. Ria serves as our Director of Patient Selection, which means she gets to work with the local health officials as well as Mercy Ships’ nurses and doctors to identify the patients that we can best help and offer free life-changing surgery. Ria is here to tell us all about the process of identifying patients and the incredible people she gets to meet. Here is my interview with Ria Bos.

Raeanne Newquist:

Ria, welcome to New Mercies. I am thrilled to have you on the podcast today because really, I feel like you have one of the most interesting, but also one of the most challenging jobs with Mercy Ships. So I’m thrilled that you’re going to sit down and chat with us today and give us all an insight into what you do. So as we start, why don’t you go ahead and tell us what exactly you do with Mercy Ships.

Ria Bos:

Thank you Raeanne. My role within Mercy Ships is to be the Director of Patient Selection, which means that I’m responsible for identifying the patients that we can help on board the ship through surgery, and at least do the pre selection, part of that, working together with the host nations and identifying strategic locations where we can find our patients and also work on safe transportation for patients that live far away from the ship to bring them safely there for consultation and surgery.

Raeanne:

You know, a lot of people ask, how do you find these patients? How do we gather these people that are in need, and bring them to the ship? And so I feel like this is the perfect opportunity to answer that long question. How do you select patients? Where do you go? How do you find them? What’s the communication to let them know we’re here? How does the whole process work?

Ria:

It all starts with good teamwork, building relationship and working on our partnership with the Ministry of Health in the host nations that we serve. I’m not doing the work by myself, I work together with the team that we have. We have two teams focusing on the specific countries we serve with both of our vessels. And then we have a clinical manager and administrative assistant, and we support from a far or sometimes nearby. Both these teams executing patient selection in the countries we start working through assessment together with the Ministry of Health and what we try to do is to understand how surgery is done in country, how the surgical provision is and where are their gaps, specific geographical locations, specific surgical specialties that Mercy Ships can offer. And from there, we start building plans both internally in Mercy Ships in the form of a surgical schedule, and determining what kind of surgical specialties we will offer and for how long and where we place them in our outreach. But also with the Ministry of Health, which geographical locations they would like us to go to identify patients, but also what other surgical specialties that they would like us to offer to come alongside.

We offer a process that is based on basically three phases. The first phase is based on registration of patients using an application on a smartphone and send local registers into the country to identify patients. We do at the same time community engagement and so we want to have conversations with key community players and create awareness within the community as well as working with posters and radio announcements. From that registration, we do a live review with a team of reviewers what means that there’s nurses reviewing these patients that are being seen in the field in real time. So a patient can be registered in Sierra Leone at 11 o’clock, and at five minutes, possibly patients will be reviewed either in Australia and Europe or in the States. And a decision will be made if the patient can come to the field consultation.

Well, there’s kind of this second phase of the process. It’s where our team goes out in the country. So we come closer to the patient’s home, the place where they were registered initially and that’s where we go see the patients and talk to them about their problem, their medical problem, and see if it’s potentially something that Mercy Ships can help. We’ll also do some education and explaining what it means to come to Mercy Ships to receive another free consultation and hopefully, surgery. And we will explain also about just transportation. We know that’s one of the barriers for people to access surgical care to access medical care. And so we try to take that out at Mercy Ships by offering free transportation from their location, far away, sometimes from the ship, that can be four or five, six hours, it can be three, four days, sometimes depending on how large the country is and how remote some of these patients live and what country we serve.

And after the field consultation, patients that are invited to come to the port to the location where the ship is docked. And that’s where the preoperative team does take over the care of the patients. And they will see patients like literally every day of the week. And what they do is welcome them again, just clarify their stories and what they have. What we don’t have in the field is that they can benefit from the CT scanner on board the ship, laboratory services physiotherapy team to do assessments. But the most important thing are surgeons that come to the ship to volunteer for shorter or longer periods of time. And they are in the hands of decision makers on surgery, this is definitely not easy, especially as some of our patients present very complex problems, they have diseases in a very advanced stage that have been neglected for many, many years. So the final decision is up to the surgeons and to also come up with a creative surgical plan. Because some of our patients really need large reconstructions of their face or arms or legs. And so once that’s being done on the consultation, that is when patients go through the admission process to be admitted to the hospital and receive surgery.

Raeanne:

It’s really a complex process. And I love that you mentioned, really the partnership with the host nation and the Ministry of Health there, I think that’s important for everyone to know and understand is that we work alongside our host nations. It’s not just we come in and impose our system upon them, if you will. But there’s a lot of collaboration, a lot of partnership, because there is a lot of work that happens ahead of time, at least a year’s worth of work that happens before the ship arrives. Now, you mentioned in these different phases that one phase is maybe the second phase is when some of the nurses go out into these remote locations, and see the patients, I know you’ve been a part of those teams that have gone out all over the African continent, and you’re in these very remote villages. Tell us what that’s like, what is it like to be in some of these really underdeveloped, remote locations?

Ria:

It’s special, I think that’s my first word that comes to mind. And I think I’m always very thankful for that it’s possible for us to go there dance. On the Mercy ship side, we have the financial resources, we have the logistical resources to do that. I think it makes us a different organization, especially at a large scale that we are able to do it. But I also think it’s special because of how we’re being welcomed, again, by our partners in the Ministry of Health or through the mayor, other like key people in the community. And just that welcome is very special, how it’s made possible for us to have a location to see our patients, sometimes the clinics, the local hospitals, that we’re going to they’re quite small. And yeah, they really make it possible for us to be there for a day or for two days, sometimes also more in the past, we’ve used other types of buildings, within the community and just how people come together to make it possible and how they already feel part of the mission. Our patient selection team grows so much in a day like that. It’s the team that we come with that we travel with what’s often maybe 10 people, maybe 12 people maximum. Then we have our local translators that are from the communities where we go, but we also have all the people that make it logistically possible. And altogether we make that team together with all the patients and caregivers that are showing up. And I think just that sense of community, that sense of being a family is very special. And we often lack the language skills, but I always encourage the team to learn the local greetings for the day. But that’s often where it stops, but a smile, just our attitudes and how we treat each other and how we pass by the waiting area where patients are waiting, it all speaks volumes to people, and especially our patients are often waiting for quite a few hours, they’re always early. And they matter. Yeah, they’re excited. And they also learn so much during that time, they observe each other and sometimes encounter people with similar problems. And they’ve never seen someone else in their lives with such a large facial tumor or with such significant burn contractures or both legs. And they also observe when we say no conversations when we do no confrontations with patients, and yeah, it’s very precious to also learn from our patients and what they give back and what they observe and what they see.

Raeanne:

I’m sure it’s like, as you mentioned, one of the first moments that these people realize, I’m not alone. There are other people that have similar conditions as I do, even though I’ve never seen them before. And I would think that there’s almost this instant bonding that happens amongst the people that are there to receive care. Now, please correct me if I’m wrong, but I would imagine that when word spreads, you know that there are going to be some nurses coming — obviously, the people who have already, you know, applied or been in contact will show up. But I would imagine that other people would show up as well. Is that the case? Do you kind of get flooded with a bunch of people that you didn’t initially expect?

Ria:

I think that’s what we were a bit afraid of, in at the beginning, when we started doing patient selection in a different way, putting in the registration phase as an extra phase. But I think it’s been working really well. At the registration, patients receive an appointment card, they know it’s a unique card, they cannot copy it or do anything special with it. And it’s very precious to them, because they want to have an answer to their medical problem. And so, what we’ve really seen is that people really will hold on to these cards, keep it and take the information that we share with them serious as in like, don’t spread this word because we want to focus on you, during this day instead of you and the 100 people we’re planning to meet. If there’s going to be two or three or 400 people showing up, that will give us less time to focus on your problems. And we really are there for you on that day. So our registrars are all people from the nation that we serve at that time, they’re really doing a fantastic job. It’s one of the things we focus on during the training that we do. They have a week of training before we send them out into the communities. And I’ve seen in each country again and again that they do such an amazing job actually, with so little training. And thankfully, I would say maybe we see 5-10 additional patients, I think what we see happening when we see additional patients are they’re often family members or siblings. And all of a sudden, maybe one patient has registered with a problem and there’s two or three siblings with the same problem. And so we’ll look at them, and we treat them like everybody else. But yeah, the resources are focused on a specific number of patients that we hope to encounter that day. So yeah, I’m thankful that the system is working. And we’re not much flooded.

For many, many years people were seeing long lines at the big selection events that we used to do. It was just harder to really focus and spend that time with the people that we can actually help with the people that we bring to the ship and shifting has really allowed us to have just a bit longer conversations do a little bit more education and also in that way just build trust, and build relationship. But we hope, especially in the very remote communities, we hope for people to come to take that step, that step of faith to go to the ship like hours and days away for from where they live.

Raeanne:

You know, I think it’s so exciting to hear how the organization has evolved and grown and pivoted in a lot of ways, and especially in the area of patient selection. Because as you mentioned, you know, people who’ve known Mercy Ships for years or have seen the pictures or the videos of the long lines of 1000s of people that come, it’s changed over the years. And as become more specific, more, as you mentioned, intentional with getting to tell these patients, we want to focus on you, and give you the most time that we can because we can help you. So I appreciate that so much, because I’m sure, even then you still probably encounter people that you have to say no to, desperate people who are in need, and you encounter them. And, you know, maybe with more investigation and more, you know, screening and testing and so forth, you find that Mercy Ships is unable to treat their specific case. What is that? Like when you have to tell patients No?

Ria:

I think part of the answer is and what you just shared, it’s a no for Mercy Ships. And I think that’s a very important thing to remember, it can feel very heavy, and especially when you work in a setting with very little resources. And yeah, most likely a setting where you think, Oh, this patient is never going to have access to surgery or the appropriate medical treatment. But at the same time, I think I’m thankful to work within Mercy Ships with Jesus and that’s who our hope is in. And I think that’s very important to know is mercy ship saying no, we cannot do your surgery. And then mainly because we want to do safe surgery, we have surgeons that are specialized in certain areas, we have nurses and as an organization has specific and unique surgical scope of practice and that’s what we’re good at. And that’s where we can provide safe surgery and care and follow up care. And so it’s important to note that that’s whhy we say no. And it’s also important just to know that Jesus isn’t saying no, it also doesn’t mean that other organizations will continue to say no, it also doesn’t mean that there is maybe at some point down the line hope for this patient in the nation as there’s a growing pool of surgeons as there’s more options for treatment in the country, maybe even more options for financial support. I think it might sound slightly idealistic, but I think it’s important to really keep thinking hopeful. And I have had the privilege of meeting so many passionate surgeons, nurses, other health care providers in the nations that we serve. And that really fills my heart with hope, even though I’m walking sometimes through facilities that I would be quite nervous about having to receive health care there or leaving a family member there. But I am hopeful because of the people that I meet both in the kind of the government settings, but also in the hospitals in small clinics, but also our registrars that are not always having a medical background, that they’re passionate about helping their neighbors, helping their family members, helping their community. So I think that’s what makes it less heavy, and especially just also the power of prayer in that I think when there is the opportunity with patients, and they’re open to prayer like we can pray together. And I think that also makes people leave in a different way from our selection sites. It’s still sad and it’s still heavy. And it very much depends on the situation, what that help would look like in terms of medical treatment or follow up during the coming weeks, months, years. But I think just shining that little bit of light and bringing that love that we can offer through Jesus is a thing, actually the most powerful thing we can bring to both our surgical patients and our non-surgical patients and that’s the bit that is lasting also.

And I think also it’s important to remember that God can do anything. So there can be an opportunity for surgery a day later, or there might never be an opportunity for surgery but God is still there. And I think they might already know that and they might just need a bit of encouragement. But maybe we are also planting a little seed and so on, then they might look different at themselves after they have encountered Mercy Ships. And yeah, hopefully we can leave a little bit of love a little bit of light and some hope with every person that we encounter when we’re out on the roads and working on these days.

Raeanne:

Absolutely. I know our very brief time on board, my husband got to go out with one of the patient selection teams to help with some security. And he will continue to say that was his absolute highlight of our whole Mercy Ships experience. And mostly because he said that the nurses that saw these patients impacted my husband’s life, because he said, these nurses took time with every single person, even if it was someone they couldn’t help and looked him in the eye, told them they mattered, extended that hope that you keep talking about it. And he said, it just it impacted him to witness that. And I think that is what is so beautiful. It’s not a no to life. It’s just a no for Mercy Ships, we can’t do this, but we serve a God who is so much bigger than what we are ever able to do. And he is able, there’s other avenues, but even just to receive for a lot of these people to receive the love, the care, the touch, you know, looking them in the eye and telling them they matter. I mean, they might walk away a completely changed person without surgery, you know, so extraordinary team that you have and that you work with. You’re not just blessing and impacting patients, but you’re impacting the communities around that. Watch the way you guys serve and work and it’s lovely. Ria, why don’t you tell us, we’ll kind of jump backward here a little bit, tell us where you’re from, and how you heard about Mercy Ships. And why did you ever choose to come and volunteer with Mercy Ships?

Ria:

Mainly I wonder what has happened in the last 10 years? But yeah, I heard of Mercy Ships from advertisements. I think Mercy Ships was trying to just kind of get a little bit more known in the Netherlands. And I joined the weekend that was offered with Mercy Ships, just to get to know the organization here a little bit more. And I’ve done a couple weekends with all kinds of mission organizations because I very clearly knew like that’s what I would like to do and kind of my chosen my path. And yeah, during that weekend, it was just different. And I think one of the things that’s very much attracted me to Mercy Ships is that I finally found an organization where I could serve as an ICU nurse. Many organizations, that was not the case that I engaged with at that time. So that was very much a plus. And yeah, just through talking with people during the weekends and praying, I clearly felt that it was also more than just short-term. So at the start, I just Yes, signed up for two years. I mean, I even want to say two and a half years, I cannot even remember. But yeah, I’d never been to the ship. I had been to Uganda one time before, and I’ve done some work in Ukraine, but never to any of the nations that Mercy Ships had served in so far. So I think my biggest culture shock actually in Texas with the on boarding program. So yeah, that’s a whole other story. But no, that’s definitely a good time. But yeah, a bit of an unexpected culture shock, I would say. And then I came to the ship. And yeah, I really love building relationships with people and especially with our patients. I wanted to know more, where were they coming from? Just how does their life look like and I think I often kind of exhausted our translators because they were like, Okay, is that enough now? I love to talk to the patients.

I worked in the maxillofacial Ward on board the ship. And yeah, it was really a very inspiring environment to work in. Pre-op had the opportunity to start working more with the patient’s pre-surgery. So I joined the team, in basically the preoperative clinic, and learned more about where the patients were coming from, could ask them more, a few more questions, and the translators were used to it a little bit more. And yeah, that’s the opportunity to switch teams. And yeah, I think it’s just really the right thing to do, it felt just good to make another like step into the unknown, it was very much unknown, like coming from a hospital in the Netherlands, where patients come in through emergency services, or they come in themselves being referred for their family doctor, this time you go out into the field, and there is a huge amount of patients waiting, and you kind of have to make decisions, who can come who also fits with this surgical scope of practice that we have. So I’ve learned a lot, and I continue to learn every day. And yeah, I think it’s the best job basically, that there is within Mercy Ships. I know many people see it as a very tough job. And it’s definitely hard work. It’s definitely complex, it’s definitely always moving around pieces of the puzzle. And not even sure if you’re working on one puzzle or 10 different puzzles at the same way. But it’s a very unique and special position to both be able to engage with the ships that we have, and all the surfaces that we’re able to offer with so many amazing volunteers. But at the same time, just have the best of engaging with very smart healthcare professionals and policymakers in the countries and passionate people on the ground there. That’s step one, to help them to serve and want to benefit from what Mercy Ships can offer. So I’ve kind of described it as a bridge function, like one foot in country, one foot on the ship. And it just exposes you to a whole complex, but beautiful kind of world that is out there. But also, yeah, it’s available within Mercy Ships.

Raeanne:

It’s awesome. Obviously, you’re in the right position, because you can just tell in the way that you’re that you’re speaking that you are excited and you are passionate about what you get to do. And you consider it an honor to get to know these people and to invest in them. I mean, the translators are saying, Okay, enough already Ria, no more questions here. But you want to get to know the people. And that’s so lovely. Of all the patients that you’ve gotten to know I’m sure there are many that have impacted you or you know, left a mark on your heart. Can you tell us about one of those patients that is impacted you over the years?

Ria:

Most amazing stories, I’ve actually seen in some of the patients that we weren’t able to help with surgery. But I think just to kind of pick out one situation, and I would very much encourage everybody just to definitely leave the ship if you have the opportunity and go visit people locally like it’s really very inspiring. And I think on one of my travels, this was a Madagascar I was traveling around with some of my local friends and on my way to visit a midwife that was working quite remotely and we met her to learn more about where she’s working and the challenges she was facing specifically in relation to obstetric fistula and that’s how I got to know her on the ship. What I didn’t know is that actually, this lady would receive the patients after surgery back into her house. And that was kind of like the hub where their family members would pick up the patients again, so I very unexpectedly met some of our previous patients that had just traveled back. They were still dressed in their dress ceremony dresses, they had made it back to this location — about a one and a half, two day travel from the ship. We had no idea that we would see each other there. So when we saw each other there was a lot of screaming and like all kinds of noises and craziness and just the unexpected meeting patients that I had seen on the ship two days away from the location was very special.

And what followed was just the whole evening in the local language in Malagasy, and I’m sharing stories about the ship with the midwife. And because my friends were Malagasy and incredibly kind, they basically translated everything that these women were sharing. And because I was the only Faza, the only foreigner in the room, they really shared freely. And we’re describing things in very interesting ways, the way how they described the elevator on the ship that would help the patients to come from the wards to an upper level to be able to go outside and get some fresh air. And they would say every day, they would go in the box that would shake and then we would go into a different world.

To hear their adventures basically on the ship and to hear how they felt they were treated by the nurses how they were dealing with the medical care that they were receiving was incredible learning experience also, in really helping me to understand also that just the rural places where some of the patients are coming from, and their health literacy is very different from patients I used to work with, and that it’s very important to really don’t like show everything we know, but have the ability to translate everything that we know, to a level that our patients are able to understand what we’re going to do with them when it comes to tests to conversations, assessments and to surgery.

And that’s why I really very much think it’s an experience, I think that would be very important for so many on the ship, just because I think it wasn’t really till that moment, and some moments I’ve had the after that encounter ,that you really start learning about where these patients are coming from. Like growing up with electricity, where it’s like a roof above my head, doors to close, stairs to go up and down — all these things, you don’t realize how special it is and how scary it can even be to climb the stairs if you never had to do it. It’s quite an experience. Sure, especially if you know the gangways on our ships, they can even be really intimidating for some of our crew members. So I think that’s just one of the many memories I have about our patients.

I’m very much a learner. And I love how I can just learn from them so much. Yeah, and it’s important, I think, for all of us to just to be really open to adapt to what our patients, our caregivers, our local workers, to what they have to share and what they can teach us about life, about their communities, about our culture, and it will make your life richer.

Raeanne:

Oh, my goodness, what a gift to have that opportunity to sit in a room with all these women who have received surgery on board the ship and really get to get an inside ear into their conversation and their honest conversation about what they thought of everything that that’s so rare. I mean, what an absolute gift that was and I’m sure there was a lot of laughing. I’m sure that there was you know, just a lot of celebrating. That’s very, very special. I love that. Well Ria as we wrap up our time together, I feel like I could ask you a million questions. I know you have so many wonderful stories to share. But one unique thing about Mercy Ships and really one unique thing also about this week, this is the week of GivingTuesday, and a week where people pause to really be generous and to donate to various nonprofit organizations all over the world. And a unique thing about Mercy Ships is that our crew are volunteers they pay to be there. There are a lot of opportunities for people to support Mercy Ships through prayer is as you’ve mentioned, it transforms lives, instills hope in people because our God is able to do more than we could ever ask or imagine, we would love for people to partner with us and pray for our crew pray for our leadership pray for our patients currently in Sierra Leone, pray for these patients. People can partner with Mercy Ships by going and volunteering with us. There are opportunities that can be found at Mercy ships.org/volunteer. We need all sorts of people in all, you know, professions to come work on board, not just nurses and doctors, but also teachers and engineers, and HR specialists, all sorts of things. But then there’s another important aspect about partnering with Mercy Ships, and that is to give financially. Ria, what would you say to people that are considering supporting Mercy Ships financially? Why? Why would this be a worthy organization to give to?

Ria:

I think, as Mercy Ships, we have something unique to offer where as I’m responsible for identifying patients, there’s also the side of providing education and training to healthcare professionals. So we really try to operate basically in two different ways in not just relieving the burden before of patients that cannot be helped with surgery or don’t have access to surgery in the countries that we serve, but also at the same time to invest in in the healthcare system that’s in place there. And especially doing that in partnership with the Ministry of Health, I think it has a lot of potential and there is a future there. We also engage not just for the year that the ship is in country, but as we engage for five years or even beyond that, as trainers, as trainees will become trainers, and that the seeds that are that are placed there, they will just continue to grow into multiply. So I think it’s unique to approach it from both those two angles.

And then also, I think, just having the opportunity to help finance the surgery and the logistics that are needed for that for patients that have not had the opportunity to access safe surgery. And the last 10 years, 15 years or so they’ve had a problem and therefore are unable to really be part of their community really miss out on opportunities in life. And through a surgery with Mercy Ships, doors are opening. People are for the first time part of their communities. And therefore, also it’s placing hope back in communities. And it’s encouraging people and I think that’s what we all need in our lives. And through being able to go through very remote communities and communities that are near the ports, were able to do that in multiple places. So I think the complexity of our organization is hopefully encouraging to give because we’re able to take care of complex problems with our partner, and we’re passionate and committed.

Raeanne:

I think you’ve kind of hit the nail on the head, that Mercy Ships leaves a lasting impact. It’s not just the lives of those who receive surgery, but the education and the training that goes into the countries and the healthcare systems where we are serving, it goes for generations then, you know, to strengthen the healthcare systems, then they’re able to continue to provide more and more aid and care for their own people. And that is that is one of our goals. And it’s a beautiful thing to support and to give to. Ria, thank you so much for what you do a very complex job in and of itself. But thank you for your heart of compassion, your heart of curiosity to learn not only about people, but about their cultures and to care for them. Ria, thank you for sharing with us today. We so appreciate you.

Ria:

Thank you so much, Raeanne.

For more information about Mercy Ships, go to mercyships.org, and to keep up with the guests on New Mercies, follow us on Instagram at NewMerciesPodcast.