Addenbrooke’s Abroad in Madgascar

Madagascar is one of the poorest countries in the world. The per capita health expenditure is about a thousand times less than that of the UK.

Some of the most remote communities receive little or no medical care. Treatable diseases go undetected and untreated. Infectious diseases are rife. Many of these could be prevented or treated at very low cost, if the needs could correctly be identified and the logistics of delivering the treatment resolved.

Addenbrooke’s Abroad is pleased to be supporting the project taken on by staff with the charity HoverAid (www.hoveraid.org) to determine the needs of some of the most remote communities. HoverAid has established an infrastructure in Madagascar, specifically servicing communities along the Mangoky river system, in the remote south west of the island. A lack of transport infrastructure and the very shallow rivers makes a hovercraft an ideal and cost effective method to reach these communities.  One of our Addenbrookes Abroad volunteers, Marjan Adlington, worked with HoverAid in Beroroha, Madagascar during August 2011, and her blog is given below.

With support from Addenbrooke’s Abroad, members of Addenbrooke’s Hospital are assisting with designing and implementing a health needs assessment for these communities.  This should enable targeted interventions, saving lives and preserving health. It should enable the planning of simple, affordable and sustainable health measures and medication programmes in the future. 

The first fundraising target is £3 000 to cover some of the cost of deploying four, two man teams for at least two periods of one week each. Specially trained Malagasies, who understand the language and culture of the population that they will survey, will make up these teams. They will visit remote communities by hovercraft and on foot, gathering structured information, which would then be analysed in Cambridge. They will be supported by HoverAid and Addenbrooke’s Abroad volunteers. This initial survey will be followed up by further research to find the best interventions to serve these communities. The knowledge gained would be made available to enable other agencies to contribute to the effort of delivering help.

Your money can make a real difference.

 Please donate generously....

 

Marjan's Madagascar Blog

 

 

9 August.  We left Cambridge in the early evening to spend the night near Heathrow at the house of one of the team members.  We are part of a team of 15.  We spend the evening reorganising  our luggage to make it possible to take tools, angle grinders, hammers, thousands of nails and eight tents, distributed as 46 kg max per person.  More about those later.....

10/11 August.  After a very early morning flight via Paris, we arrived at Antananarivo, the capital of Madagascar, late in the evening.  It took a long time queuing for our entry visas.  We were the last to leave the airport because one of our bags was missing. We were then driven to a government guest house were we all had an extremely good night's sleep.  The next day we met a number of the local staff of HoverAid for a briefing session, prior to moving on to the bush were we were to spend the next 17 days and nights.   We repacked our luggage once more due to weight restrictions on the plane which half of us would be flying down in.  The rest of the team were travelling overland - an 18 hour journey.

12 August.  Despite our best efforts yesterday, we still had to remove more weight from our luggage before we could take off in the 10-seater Cessna plane operated by Mission Aviation Fellowship.  As we flew over Beroroha we could clearly see the river systems and the town itself.  It was obviously remote.  HoverAid has made a very conscious decision to work in this remote area mainly because no one else does.  Our arrival at the air strip is watched by a local family who may have seen this plane before, but probably not such a group of blond‑haired foreigners.  We are met by the local HoverAid team.  Nine of us manage to fit in to the Landcruiser, with all our luggage on the top.  We travel through various villages and see a lot of poverty.

 After about 30 minutes we arrive at the Mangoky river, where we have to wait for the peroques (punts) to come and pick us up and take us across the river.  It is extremely hot, without any shade.

 Two peroques arrive and we fit all the luggage on one and ourselves on the other.  A lovely ride over the water and when we arrive at the other side, the HoverAid ox cart with two oxen (Zebu) await us.  Luggage goes in the cart and we follow the cart and walk to the camp.  We are well and truly a long way from anywhere!

After lunch we check-out the area.  One of the visits we make is to the local hospital where I will be working for most of the next 17 days.  Although I have lived in the Middle East and seen the local hospitals there, I have not seen anything like we saw that day.  There were no beds on the wards, just a few mattresses on the floor.  The maternity ward had a family in it with a baby that was born just hours earlier.  They all were on the floor and it was really quite dirty.

15 August.  Today five Malagasy doctors arrive, as well as our British GP, Mandy.  We make our way to the hospital, and there are a few hundred people waiting to see the doctors.  The news about their arrival had been broadcast on the local radio station.  We have two rooms - one for the GPs and one is a makeshift operating theatre.  The doctors have brought two large boxes full of medication with them and Mandy and I set about bringing  some order into all this by separating all the antibiotics together from the rest.

As soon as possible we start to see patients.  They all seem to have a small booklet they bring along.  The doctor writes in it what is prescribed and it is stamped with the HoverAid stamp.  A small sign of medical record keeping!  Patients have to pay a small amount for the consultation and the medication (the equivalent of 30p or 60p) Surgery costs about £2.50 and having an ultrasound scan costs about £6.00.  The reason that a scan is so expensive is because the locals believe that the scan can heal them: the cost is to discourage people from asking for one!

16 August.  More patients today and a rather sad ending .  An eight year old girl drowned this afternoon in the river where lots of kids were enjoying a cool dip in the water.  The HoverAid hovercraft was used to search for her.  One of the family members came along, but unfortunately she was not found.  We find that the atmosphere around the river changes dramatically.  We see families sitting near the water and staring out over the river.  It is a forlorn sight and, not surprisingly, it has quite an impact on our group.

Three of the Malagasi doctors are surgeons and they spend their days doing lots of circumcisions, hernia repairs and removal of a bladder stone in a 25 year old man.  More about him later....

18 August.  Mandy, our translator Andry, and one of the Malagasy doctors  and I are going to visit a village up river today.   We will travel by hovercraft for about 90 minutes.  We take a large box of medicines and are looking forward to being able to get out of camp today.

When we arrive, there are loads of kids who are running towards us.  We unpack and have to wade through part of the river to get to the path that takes us through the paddy fields, through a stream or two, up a hill and into the village.  We are welcomed by the chief and they put out a tarpaulin under a tree where we unpack our 'wares'.  The plan is to see as many patients as possible in the next three hours.  All those who want to see the doctor give their name and then we start going through the list.  Everyone sits around: the whole village knows what is wrong with everyone.  Lots of laughter when anyone needs their tummy examining.

We manage to have a look around the village and see how many huts there are, what other buildings are in the village and we speak with the chief to find out a little more about the number of people in each family, etc.  The people of this village have the river as their only water source.  It is used for everything.  The villagers have no latrines, they go into the woods to do what they need to do.  How wonderful would it be if these people had access to fresh water.  Less diarrhoea and fewer other diseases hopefully.  It may be a long way off but we should try to do what we can to help these people.

This has been the best day so far and very rewarding.  The village people are lovely.

19-25 August.  Today the Malagasy doctors are flying back to Antananarivo, and it transpires that Mandy and I  are expected to look after some of the surgical patients. 

We follow a pattern of visiting these patients morning and evening, hand out medicines, change saline bags, give antibiotic injections, change dressings for the hernia patients and the boy who had a bladder stone removed.

Over the next several days we continue to see patients with all kinds of issues.  There are lots of STDs, malaria, signs of TB, stomach ulcers, Bilharzia and other parasites.  Praziquentil is a very regular hand-out.

Wherever we go the people know there is still a doctor about and come to see us, sometimes in the middle of the road.  Mandy shows masses of patience and kindness and never says 'no more'.

In the meantime, the rest of the our group are engaged in the re-roofing of the local market place in Beroroha and are doing an amazing job.  They are also building concrete bio sand filters which at the campsite.  This is hard labour and dirty work, but by the end of our time we will have built 18 of them.  Quite a few have gone to local families who have been especially chosen to have one of these filters.  They will act as role models for the rest of a village.  The hope is that their family health will improve and others families will also want a water filter for their home and family.

Two villages have dug a well with the hope of finding water for the first time right in the middle of a village.  On one of the wells, water is found at 15 meters, the well is lined with bricks by local men and by the end of our second week, water is drawn from this well for the first time.  The whole village is present and there much rejoicing.  They can hardly believe their eyes.  This water will be much cleaner than what they normally drink from the river.

26 August.  Today is the official opening of the re-roofed market place by the mayor of Beroroha.  We start off early and are kept waiting for some time.  But then the official party arrives, lots of people gather around and speeches are made.  As soon as it is all over, the local traders immediately move back in and start selling their wares.  Everyone is happy.

27 August.  Today is the day we take the catheter out of the boy who had the bladder stone removed.  He is instructed to drink lots of water but by the time evening arrives, it is clear that there is a problem.  He is unable to pee and fluid is coming out of the wound.  There are no catheters in the hospital and we retreat back to the camp for a long hard think.  I won't go into details, but we find a way of putting together a makeshift catheter and insert this – all is well (for the moment).  We are due to leave the site on Monday (29th August) and start discussions on what to do with this boy.  He will need more surgery, but this can't be done in Beroroha without surgeons.  Antananarivo (Tana) is a long way away, and the cost of medevac by plane is huge.  After consultation with the surgeon in Tana, and a surgeon in the UK (Addenbrookes actually) to confirm diagnosis, it is decided that he will fly back with us to Tana on Monday.  Dr Fernand will meet us at the airport and take him to the hospital.

28 August.  Mandy is leaving today and leaves me to care for our bladder stone patient.  He will need to have his dressing changed and the catheter cleaned out.  This all goes well, but some time in the night the catheter comes out and fluid drains again from the wound. He will now have to wait till we get him to Tana on Monday.  The flight back to Tana is a whirlwind of new experiences for this boy who has left his village to come and see the doctor, but who has never been anywhere else, and certainly not in a plane. 

29 August.  The end of our trip is close now and in many ways we are sad to leave these dear people behind.  It has been hard work, very, very hot and the days and nights were long.  Time passes slowly.  Sleeping in tents has been a hot and sandy experience.  We are all looking forward to a clean bed, hot shower and generally feeling clean again.