Orthopedic Surgery

 Many different kinds of surgery happen on the Global Mercy. If you look at their website or social media you will see tumor on faces, hands stuck in a fist from a burn scar, people who have hernias, and then my favorite orthopedic. This is kids ages 4-10 who have bowed legs or knocked knees. This is in general from one of two different diagnosis's: Blount's disease or Ricketts. Blount's means they were born with weak bones that can more easily bow. Ricketts means it is a dietary deficiency, especially in the first few years of life. These hallow bones bend more and more as they get older, under the weight of their upper body. Whichever is the mechanism for injury, Sierra Leone has a lot of kids with bent legs. We are able to do surgery on approximently 60 each year we have come and every time there is a waitlist. 

These kids are outcasts of society. Mercy Ships sends people into villages and shows them pictures of bent legs and often the answer is no, they don't know anyone like that, because they are hidden away. I have met so many children who have never stepped foot into a school. They don't know how to count, write their name, know their colors. Some are slightly better off and help with chores around the house, but never to be seen by anyone who is not part of the family. Stories of fathers who have left families because they think the child is cursed. 

I'm always amazed by how functional from a physical therapy perspective they are when I meet them. They can stand on one leg, go up and down stairs, do squats, etc because they have to to survive and keep up. When I ask about goals (what is rehab without goals??) the #1 is always "to not be mocked by neighbors" and #2 is "to go to school". 

Both last year and this year I feel like my heart grows by 50 kids. I no longer have just my 3, I now have 53. :) Their triumphs are everyones triumph. Their frustration is mine too. They scream in pain and in fear. So much fear... how would you feel being stood up with two legs in casts all the way from foot to mid-thigh? We blow bubbles, sing songs, and show love and attention to them in all the best ways. My heart wants to burst every time I am at work. I am exhausted at days end, but in the best way possible. I truly believe this is what I am called and equipped to do, and living in that space brings so much joy. 

Doris

Aminata

Please be praying for me as I not only help legs get straight and strong, but more importantly love these kids and their parents and hopefully point them toward Jesus in the process. 

Let me know if you have any questions. As always, we are so thankful for you support 

Black Tax

I was sitting across the coffee table from Sophia as I was learning about her life in Nigeria. "Black tax" she said, was what held many Africans back but also was the social security net for families.

"Black tax" is the common term used for when African expats who have moved abroad are obliged to send a portion of their income to their families back in Africa. Especially the oldest, usually son, must do this. 

This is a tax on that person's ability to save, build up wealth, buy a home, or otherwise move up, ecomically speaking. It's similar to when parents pour all their time, attention, and money into their kids' education hoping and praying that they can one day go to college. 

As I (Jeff) oversee the finances of the ship and lead our crew bank (where crew can receive donations, save money, withdraw local currency, and use it for basic supplies like a toothbrush or a soda), I see the way money is handled. Africans and those from the Global North act, treat, and use money very, very differently. 

It is not a tax from the government. It is a societal and familial tax. Because if you have even the slightest amount of money, you're expected to share that when someone asks. You must say "yes". 

This is why it is common that, when you get paid or somehow get a windfall of money, you immediately go out and buy bricks for your house or some other physical asset. You've converted your cash (an asset) into another asset — bricks, wood, fuel, roof material, etc. Then, you have no money and, thus, you can say "Sorry, I don't have any cash".

So while we in the West may feel the squeeze as we need to take care of our children and also our aging parents, it is still quite a bit different here where there is no governmental social security income, medicare, or other safety nets — you are that safety net.

Helped by George in the dark

When the weather is not terrible (i.e., the smoke, pollution, and Sahara dust) I enjoy a morning jog up into Freetown — usually 5-8km. This morning a Sierra Leonean was also running, caught up to me and began a conversation. Jeff is not a common name here, but it is still easier than many other Western names.

I was running solo which is rare, and so when a Sierra Leonean came up alongside me, I was a bit apprehensive but I knew the route, it was well lit, and there were other runners behind us. So we started talking, as strangers around here do. Being white, you are automatically popular. People want to know a white person, say hello, and practice their English. Also, Sierra Leoneans are also very friendly. So we jogged and in basic English and Krio over the next two kilometers we got to know each other. He runs Monday-Saturday and does not run on Sundays (I didn't understand if he is a Muslim or Christian). He is at college and plays football (soccer, in America).

While jogging back to the ship, I kept thinking "I was looking forward to a solo run and to enjoy the semi-peace of the morning with all the honking from kekes, cars, and large diesel-powered trucks chugging up the hill blowing out plumes of dirty diesel exhaust out their sawn-off tailpipes." Nope. Not today. He wanted a conversation. So then I thought, "God, why did you place this person next to me?" and then I remembered the proverb "a cord of three strands is not easily broken." I pondered that for the next kilometer.

Then I suddenly tripped on the concrete and while I likely would not have fallen, George instantly grabbed my arm to stabilize me with his lightning-quick reflexes. "Tenki ya, George!"

I had my headlamp on, my florescent green/yellow shirt, and while I was not concerned about getting hit by cars, I misjudged jumping off the 18 inch curb and did not see the lip of the concrete in the morning twilight. Sierra Leone is in the Northern Hemisphere, so it is still winter here — if you can call 79º Fahreinheit at 6am "winter". The sun had not yet risen at 6:40am.

I guess my lesson and takeaway is that sometimes there is goodness that comes from strangers in the dark. We're taught to always be on our guard and to not talk to strangers, and while that is still a very good and important approach — especially in raising up our kids! — it may happen just to prove that there can be goodness and beauty in this broken, impoverished, and needy world in which we live. 

I later looked up the full passage for the proverb in Ecclesiastes 4:9-12 and smiled.

Two are better than one,
    because they have a good return for their labor:
10 If either of them falls down,
    one can help the other up.
But pity anyone who falls
    and has no one to help them up.
11 Also, if two lie down together, they will keep warm.
    But how can one keep warm alone?
12 Though one may be overpowered,
    two can defend themselves.
A cord of three strands is not quickly broken.

Lines 3-6. Ironic for my morning. Right?

While not this morning, here is what my typical route looks like in the afternoon:

Usually about 80-84º F and 80-85% humidity. 

Letting Go - Part 3 of 3

Letting Go (of projects, ownership, and the next chapter)

This third part is more personal. It’s about letting go of work you care about and accepting that you won’t see it through in the way you originally imagined. It is the handover.

I’ve put a lot of time and energy into this hospital project. Many evenings, meetings, conversations, write-ups, and much mental space. I care about the tools and processes, but more importantly I care about the people using them—the nurses, surgeons, coordinators, and admin staff — and the patients. I care about what it means for them to have systems that support their work and their patients.

It isn’t easy to hand this off when it means so much.

Not Seeing the Finish Line

Part of the difficulty is attachment. I invested deeply in this and want to the end. I'm built that way. You want to finish the work before leaving. We made real progress, but we are nowhere near a long-term solution and I won’t be the one carrying it onward.

Because I really believe in the work being done here in Africa, it is time to hand it off to someone better, someone who can dedicate time and energy for the long haul. If I believe in sustainability, I am not it.

Most Projects Don’t Start and End With Me

Very few of us get to take a project from the true beginning to the true end. Especially here, where many volunteers rotate in and out. Leadership, priorities, and structures shift.

I’ve begun asking questions like: “Was I helpful in the time I had?” or "Did I make a difference?" When I look at the work that way, I see a lot to be grateful for. We reduced some of the administrative load. We made things easier to manage. We highlighted problems. We brought clarity to a complicated area. And we learned a lot along the way.

What Was in My Control—and What Wasn’t

Some of the challenges were tied to broader issues—silos, communication patterns, poor systems/tools, and structures that existed before I arrived and will exist after I leave. Those aren’t things one person can change. I can suggest improvements and model change, but I can’t reshape the whole system. Also, to think it is all on me is naive, stupid, and arrogant. There are many, many great people working to improve the organizational health.

So part of letting go here is simply accepting that I played my part, and now the work moves on to someone else.

As I hand this off, I’m trying to keep a few thoughts close:

• I did what I could
• I learned from it
• I hope the next person can take it further
• I am cheering them on

And I’m at peace with that. 

I hope you can let go and appreciate the difference you make in your world. 

Communicating With Stakeholders and Learning Where Influence Really Happens - Part 2 of 3

Sometimes a Meeting Beats an Email

Do you want to be effective, or efficient?

This second theme that has emerged from the hospital work is around communication and influence. Not communication in terms of “Did I send enough updates?” but more, “Did I talk with the right people, in the right way, early enough?”

Looking back, I can say I did a lot of communicating. I talked with people on the hospital side. I talked with people back at headquarters. I kept our operations team in the loop. I kept the project manager up to date. I shared what we were doing, what we’d improved, and what the results looked like.

Even so, there were key people who did not have the level of visibility or relationship they needed if this was going to move from a local proof of concept into something longer-term. That gap only really became clear to me later. 

The Value of Meetings (effectiveness)

To make it worse, asynchronous updates (messages and emails) were helpful for many but many others needed meetings to engage the challenges and nuances. One of my lessons is that there is usually “one more level up” I haven’t connected with yet. The people who get copied on emails are not always the same people who have ownership, or who remember you and your project when broader planning happens.

Mistakes were made. Sending emails or messages is not the same thing as building a working relationship. In many cases, the content could have been shared asynchronously, but the connection and trust needed for buy-in would have required at least one or two real meetings. I didn’t push for those enough early on. 

You Can’t Talk People Into Caring

I tried to make the value clear. I showed examples of time saved and errors caught. I explained what this could unlock for the hospital if we kept going. But if someone is stretched thin, has other priorities, or doesn’t really know you, they may not have the capacity or the context to engage. Some of this is basic, some of this is cultural, and some of this is the English used. 

If I rewind this, a few things I’d do differently:

• Involve more onshore teams earlier and more deliberately
• Get introductions to people I didn’t know
• Build relationships before solutions
• Accept that you just can't win 'em all

Even with all of that, I’m still grateful for what we were able to accomplish. The Pre Op team’s workload became  lighter. Their days became a bit more manageable. The changes mattered, even if the project management communication lacked.

So this second story serves mostly as a note to myself and to others: communication isn’t only about clarity and frequency. It’s mainly about connection. It’s about whether the people who need to be involved actually feel connected to you and understand the work in context. That’s something I’ll pay more attention to going forward. Because to go forward requires relationship.

Proof of Concepts, Progress, and the Realities of Helping - Part 1 of 3

Proof of Concepts and Small Steps in the Hospital

When I think back on this field service (thus far), one of the themes that keeps coming to mind is the value of trying small things first. Not huge systems, not big redesigns, but proof of concepts and small changes that help people see progress.

Coming into this year, the hospital was asking some fairly tough questions. There was a sense of, “How are we going to manage this workload?” Pre-Op in particular was working long days, often from 8 in the morning to 7 or 8 at night. Doing their best, but exhausted. There was much work, a lot of admin, and many spreadsheets that were harder than they needed to be.

Our thought was: if there’s anything we can do to make their load lighter, we’d like to try. Even if that’s something fairly small.

What we did was not fancy. It was cleaning up spreadsheets, making workflows consistent and simple, and making it easier to see and manage the information. We weren’t replacing everything. We tried to make what already existed more usable and less heavy.

We could see the difference in a few ways:

• Less time spent on certain recurring tasks (cut 1.5 hours per day for one person)
• Fewer errors and stumbling blocks (found over 150 errors on day one)
• Better visibility into what was coming next
• Going from 78 tabs in Excel to 10 (!!)

To be fair, some of the improvements also came as the team got into a rhythm. Not everything is about tools or process; part of it is people learning to collaborate. We can't nor want to take credit for things that weren’t ours. But we do know that the changes we made helped, and the hours saved and errors reduced were real, not theoretical.

Why Proofs of Concept Matter

This reinforced for me that people can only listen to general promises for so long. A leader (CEO, president, manager, or prime minister) can restate the vision only so many times before it means nothing. You can say, “We’re going to improve this,” or “We’re working on a better system,” over and over, but if nothing changes in their day-to-day work, it’s hard for anyone to believe and support it. A small, working proof of concept goes further than a million words or a thousand promises.

Waterfall-style projects—long planning cycles with little visible progress for months—drain morale. What helped here was taking one piece at a time, improving it, and then doing that again somewhere else. It brought attention, insight, and a collaborative environment. It was also quick.

Iteration Is Just The Start

As helpful as the proof of concept was, it wasn’t enough by itself. Sustainability still needs leadership alignment, ownership, and advocacy from the right people. Small improvements spark energy, but can't carry themselves.

People tend to join tribes and projects that are going well. We want to be associated with what is "moving up and toward the right". That isn’t negative—it’s human. Small working improvements help generate that interest and momentum.

So for me, this first story is about that: using small proofs of concept to show what’s possible, to lighten the load a bit, and to remind myself that progress here is usually incremental, not all-or-nothing.

Part 5 – Giving Hope and Healing — in Spreadsheets

If you’ve been following along in this series, we’ve talked about my first steps into the hospital, the value of building good habits, caring for the Finance team, and learning to leave space in conversation. All of those threads lead here: giving hope and healing through spreadsheets.

Mercy Ships’ tagline is “bringing hope and healing to the world’s forgotten poor.” We mostly think of surgeries — a child with bowed legs walking straight for the first time, a person blind from cataracts seeing their family again, a patient with a massive tumor finally lifting their head without shame. That’s the heart of what Mercy Ships does. Healing, restoring hope, giving dignity.

But this post is about something different and nerdier: how God used a finance/software operations guy to help bring hope and healing not through scalpels or pharmaceuticals, but through spreadsheets and process optimization.

The Doorway In

When Jackie and I joined, my role as Finance Director made it possible for our family to serve onboard. My “job” was numbers, not patients: budgets, bills, day crew stipends, crew bank operations, cash forecasts. Jackie worked on Deck 4 with patients in Rehab. She had patient stories; I had account reconciliations on deck 8. And that was fine — Finance keeps the ship running.

That changed when I started working with the Pre‑Op team in August 2025. They had a massive spreadsheet problem: 71 tabs, one tab per patient cohort. Every reschedule meant cutting and pasting data between tabs. It was inefficient, and long days — 10 to 12 hours — were the norm.

Taming 71 Tabs

We consolidated everything into one structured sheet, added error checks, built filters and reports, and created a single place to manage patient flow instead of a spaghetti mess of copy‑paste.

• Admin assistant: saved ~30 minutes every day on reporting.
• Driver coordination: ~4 weeks of work down to ~1 week.
• Immediate detection of 80+ duplicate errors.
• Patient lookups: ~2 minutes down to <30 seconds.

Now, printing for other teams is a filter, not a manual paste. Rescheduling patients means picking from visible open slots because for the first time. you can see all available slots for the full field service. Planning for buses from up‑country uses projections, not guesswork. And more teams can finally see the same data: one source of truth. 

Lest it sound amazing, it’s not — there is still a lot of manual work, too many spreadsheets, and many opportunities to do more. This is not a story about “how great it now is” but a story of small incremental changes and the journey of getting there.

Why It Matters

Yes, it’s nerdy. But it’s also about people: an admin assistant goes home 30 minutes earlier; a coordinator plans instead of reacts; managers answer with confidence. When help is needed, it is less on feelings — “We’re underwater and have too much” — and starts running on data: “Here’s our caseload, here’s our capacity, here’s what’s next.”

That clarity changes leadership decisions, reduces the cognitive tax, and builds trust. It gives patients a better experience because the hospital isn’t scrambling behind the scenes.

God’s Irony

Here’s the part that makes me smile: God brought this finance/software operations person halfway around the world to help a hospital team in Africa by… fixing improving processes. Not performing surgery. Not running rehab. Spreadsheets. And yet they reduced stress, saved time, caught errors, built trust, and created margin. That margin creates rest, energy, sustainability.

From “We’re Underwater” to “Here’s the Data”

Before: “We have too much and the field service just began. We can’t imagine later when there are even more patients.” After: “Here’s how many patients we have. Here’s our capacity. Here’s what’s coming. Here are the obstacles that need to be resolved.” That shift turns frustration into information — something leaders and teams can act on.

Closing the Series

From open eyes and listening ears, to good habits, to caring for the team, to leaving space, to spreadsheets — this journey is teaching me that no act of service is too small. Spreadsheets or surgeries, what matters is that we are a team and we act like one. We are one and are all here for the mission. And in this season, God found a way to use the work of the Finance team to serve the mission of Mercy Ships.