Hopitaly Vaovao Mahafaly,
Clinical interest: General surgery
Planning and Organising
We found details of the hospital through the Christian Medical Fellowship website, and had both heard about it through friends who had previously been and enjoyed it. The doctor who we coordinated with was very helpful in answering any questions we had and helped us plan transfers and accommodation in Madagascar.
The hospital functioned in French as this is the second language of Madagascar. The staff running the hospital were 2 Malagasy doctors and 2 British doctors with their partners. In addition to this there were various short-term missionaries from the UK and Switzerland working in the hospital. The nurses were all Malagasy but also spoke French.
A day in the life
A normal day in the hospital started at 7:30am with a meeting giving an evangelical message and health education lesson to staff, patients and visitors in the hospital. The ward round followed this at 8am. There were three ward rounds which took place – medical, surgical and maternity. Both the maternity and surgical ward rounds were fairly short and so once they were finished you would go to out-patient clinic or into theatre to begin the list for the day. The medical ward round usually took longer, taking up most of the morning. At 12:15 we would break for lunch and we returned to the hospital at 14:15. The afternoons were generally much quieter and time could be spent in theatre, on the ward or in out-patient clinics.
Throughout the placement, the doctors were very willing for us to get hands on experience where possible, particularly when in theatre. I assisted in multiple laparotomies, and a caesarian section, and by the end of my week in theatre my sutures were much tidier and took less time! The theatre was fairly basic, they tended not to do general anaesthetics with intubation unless muscle relaxants were necessary, and so ketamine was used as an anaesthetic agent, or lidocaine for a spinal anaesthetic. They also washed and reused all equipment where possible, this included intubation tubes and Guedels. They did not have laparoscopic technology and so all operations were open! There appeared to be a pattern in the operations that were performed, the majority being urological, gynaecological or obstetric, with a number of exploratory laparotomies to investigate the bizarre presentations!
The hospital have a medical teaching session for all doctors and students on a Tuesday afternoon. It is led by a member of the team and rotates each week. In my fourth week there I was asked to do a session on neonatal jaundice with the paediatric doctor. We also received teaching from our supervising doctor. We covered topics such as schistosomiasis, malaria, typhoid fever, tuberculosis and giardia. This was very useful as these are conditions that aren’t commonly seen in the UK.
In Madagascar there is no National Health Service or health insurance, any treatment you receive you have to pay for. This can be quite expensive! As a mission hospital HVM has a charity fund which subsidises the cost of treatment provided. Patients still have to pay, however it is not as expensive as at the government hospitals.
The service provided in the hospital was very different to home, however, they have a system of protocols to follow which works for the majority of patients. From early on in our time there, it was clear to see that the majority of disease burden was a result of schistosomiasis, malaria and malnutrition.
When we weren’t in the hospital we spent time with the missionary families, often going for walks and having meals together which was enjoyable. We also had some time to just chill and read in our accommodation, which is something I rarely find time for back home, so that was great too! One highlight for me was going on a run in the morning with a few of the missionaries there. It’s too hot during the day for exercise and so a group of people meet at sunrise two or three times a week to go for a run. The views were beautiful! It was quite hilly though so also hard work, but definitely worth it!
I thoroughly enjoyed my time in Mandritsara. The team of doctors and their families really made us feel welcomed and part of the community! We were exposed to a variety of interesting medicine, and feel I have learnt a lot from the experience. I am extremely grateful for the opportunity to spend time in Mandritsara and would love to return at some point in the future!
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