On Malagasy Time

We stayed overnight at the Ivato Hotel in Tana bc JillRae, Chesley, Dr Joel, and Maureen didn't fly out until this afternoon. We spent the morning at the Faza mall (white people mall) and then went to the Gastro for lunch. The Gastro is the big "fast food" restaurant in Madagascar that serves really good pizza! Normally I try to avoid eating American food while in other countries but this was an exception! So good and so interesting to try Madagascar's version of pizza... soft thin crusts, light sauce and lots of yummy cheese mixed with herbs!

We dropped JillRae and Chesley off at the airport for their safari in South Africa. Pizza ran a little late and we didn't think it was gonna be a problem to arrive 2.5hrs before takeoff but we ended up cutting it real close! Checking in the bags and people took over an hour and they finally got everything squared away 30min before having to board the plane! So we learned the 3hr buffer is a mandatory in 3rd/4th world countries! We're definitely going to miss JillRae these next couple weeks bc our dream team is now down to two! 

Our journey back to Antsirabe should've taken about 3hrs but a few unforeseen events transpired that drew out the journey to over 7hrs. About an hour into the trip, Pastor Honey had to pull the van off to the side of the road bc the engine was overheating. Turns out the electrical wire had shorted and we had no power in the car. This means no lights, no power steering or breaks, and no way to cool down the engine. We were about 15min outside a semi large town of Ambatolampy and therefore coasted into town as the sun was setting. We tried to find a mechanic but no one was open. 

While waiting for a solution, the town power went out and we were completely surrounded by darkness. The only concerning part about this was that our car had no lights and we were a sitting duck on the side of the road. Cars and trucks roared by causing our van to shake multiple times. Pastor Honey made some more phone calls and got in touch with his uncle-in-law who lives nearby. The uncle loaned us a small car to use to get to Antsirabe since it wasn't very safe to stay in this town. 

7 people with overnight bags + 1 small sedan makes for a tight squeeze for 2 more hours! Pastor Honey drove with Domoina and her mom in the front seat and Scarlet, Njiva, and I in the backseat with Meg laying horizontal across us. The car took a second to start and the dashboard didn't light up but it had 4 wheels and working exterior lights so we were good! We didn't know how much gas was in the car bc the dashboard didn't work so Pastor Honey went to find a gas station. The first one was closed bc there was no electricity in the town. The next one was in the process of pumping gas and therefore we couldn't fill. And the 3rd gas station we passed was about 20km away from Antsirabe so Pastor Honey didn't stop bc we were so close to home.... 

Well we made it to the Antsirabe city limit sign and then all of the sudden sputtered to a stop and we were stranded yet again! Fortunately we weren't in the bush anymore so it was a little safer but still not the ideal situation bc we were on the side of a dark road where trucks and vans were flying by. Dr Harison came to our rescue with gasoline and we filled up the car and made our way to the hospital! I've never been more happy to make it home than I am tonight!!!

 

We like to move it move it!

This weekend we traveled up to the National Park of Andasibe to see the lemurs. The park is 3-4hrs east of Tana so on Saturday we loaded up the vans and drove north to the capital. We stopped at several small markets along the way to pick up souvenirs. We ate lunch at the mall in Tana before continuing east to the national park. It was a total of 6-7hrs of travel (290km) that included lots of CME learning, Disney singing, and sleeping. 

On our way there, we saw a 3 car train on the tracks and all the Malagasy interpreters got very excited! I had noticed earlier in the week how the train tracks always had a lot of people walking on them but didn't really put two and two together. Eleanor explained to me that the government built a lot of train tracks across the country but the trains aren't used very much so now people use the tracks as pedestrian walkways. 

We arrived at Hôtel Feon'ny Ala around dinnertime and got settled into our thatched bungalows. There were 4 twin beds nestled in the loft and 1 full bed on the main level of the bungalow. JillRae, Yolanda, Meg and I took residence in the loft while Chesley was able to enjoy the main area without our craziness bothering her! The hotel is appropriately named to mean "Song of the Forest" bc the bungalows literally sit on the edge of the Réserve Spéciale d'Analamazaotra and we woke up to the roar of the lemurs calling out to each other. 

The next morning we packed up our things and headed to Vakôna Lemur Forest. The lemurs live on an island separated from the mainland by a small strip of river. We had to get on a canoe to cross and then we were surrounding my fun-loving lemurs eager for bananas! The most surprising part of the lemurs was how light they are! They would gently jump onto your shoulders and begin climbing all over you for fun!! We got some great pictures and videos and JillRae had a lemur friend follow her back to the boats, clearly asking to go home with her to America. 

Our group was so large that the Malagasy guides couldn't take us all out on the canoe adventure to the other lemur islands at the same time. But several of us who have been canoeing before volunteered to paddle so the whole group could go together! We found several other pods of lemur families and even a couple babies hanging onto their mamas! 

The ring tailed lemurs were the last ones we saw bc they are secluded from the rest of the lemurs. Apparently they can get a little feisty and don't play well with others...

After the lemur park we drove west to Moramanga for a birthday surprise! Today is Ebony's 29th bday and yesterday was Pastor Honey's bday so we ate lunch at a French bakery where they had custom cakes made for them!! Both were so surprised and the cakes were delicious!

We continued on to the chameleon and reptile reserve to see some of the native reptiles. We saw geckos, snakes, chameleons, and more! The chameleons were beautiful colors and ranged in size from a few cm to over a foot.

This was our last stop as a group before heading to the airport so naturally we had to take a group picture and video everyone dancing to "I like to move it move it". Definitely going to miss this amazing group of people!!

Clinic 5: Antanifotsy

This week has flown by! I can't believe its already the last day of clinic and the team leaves this weekend. We drove North to Antanifotsy about 1hr away and set up at this beautiful Lutheran church that had a school attached to it. I was working in Triage with Yolanda, which was so fun bc you got to meet almost all of the 300 patients who came through to be seen! 

The time in country has been like no other that I've experienced before. We have seen disease states that are so severe, unusual, or non-existent in the USA. Patients here just don't have the same access to care that they do in other countries and therefore you never know what is going to walk through the front door. We have seen:

• * Measles 
• * Hansons disease (Leprosy)
• * Cleft palate
• * Meningitis
• * Active TB
• * Mycobacteria lesions
• * Osteogenesis imperfecta
• * Cerebral palsy
• * Abscess with severe hand cellulitis
• * Healed displaced tibia fracture 
• * Scabies (full body severe)
• * Wilson's disease 
• * Klippel-Traunay syndrome

The saddest case today was a 1yo baby girl with hydrocephalus. Her head was the size of a small watermelon and her young mom was beyond distressed. Her sweet baby girl was considered a freak show and she had no access to medical care bc of cost. One of the nurses on the trip works in CHOAs neuro unit and has seen this condition before. She said that if the babies receive shunts to drain the extra fluid early, they can live much better lives but this little girl was the most severe version she has ever seen. There wasn't much we could do except try to get a shunt from CHOA and have it mailed to Dr Harison to do the surgery. But we couldn't send this mom home empty handed so we prayed for her. Pastor Mike was with us and he prayed over the little girl and her mom to send the Holy Spirit to guide their way during this hard journey. 

The drive today was the prettiest we've had all week. We were driving through the river lands so it was lush and green and beautiful! There were green rice patties and farmland for miles on every direction. And people were working tirelessly from sun up to sun down to earn their wages. Their work effort is unbelievable! 

Since we ended our clinic a little early, we had time to go by the Toby, the Lutheran psych hospital. It's a very unique place bc it provides a safe haven for psych patients and their families to live. There are no anti-psych meds in Madagascar so these patients have to suffer through their mental illnesses with just family support and some care giver help. We arrived and were greeted by one very enthusiastic patient who was very adamant about keeping our group together. As we rounded the corner, the reality of the psych facility hit us as we saw the patients in raw form. The patients who are a danger to themselves or others are actually physically restrained with chains. If the person is a flight risk, they're feet are chained. If they're a risk to themselves or others, they also have their hands chained. And if they're having a psychotic break, they are chained to their beds with family nearby to take care of them. It was absolutely heartbreaking to see that this was their best option! But it was also so encouraging to see how integral the family members are. So often in the USA psych patients are locked away in facilities for others to take care of them. It's very apparent how important family is and how they drop everything to take care of each other. 

After this somewhat draining experience, we came back to the hospital for a 180...  Dr Harison and Domoina put on an amazing BBQ for the Malagasy interpreters/staff and us to celebrate the end of a fantastic week. There was more food than I have ever seen before and it did not stop! They had tents set up outside the guest house overlooking the setting sun over the town and we had an amazing time. After dinner JillRae pulled out the guitar and bongo drum and we played battle of the bands between the Malagasy and Americans. Clearly the Malagasy won bc they're music was so much better! 

Our experience with the Medical Missions Team has been an experience for a lifetime. We saw over 2300 patients in 5days and gave out almost all the medication we brought (17+ suitcases). It's been an exhausting week and I don't think I've ever been so tired at the end of each day. I'm so sad that everyone is heading back to the US bc it has been such a dynamite team! I'm glad we have a couple days left to hang out and play with the lemurs:) 

   

Daily devotion from Megan: 1 John 4:19

“We love, because he first loved us.” -1 John 4:19

It seems only natural to end this week of mission work with Megan's favorite verse bc it has such a powerful message.  The verse 1 John 4:19 is the heart and soul behind why, I personally, choose to serve on medical mission trips, however it applies to everyone. The passage that surrounds 1 John 4:19 lays out how God defines love, how God shows His love, and how, as Christians, we are instructed to love.  To loosely paraphrase: first and foremost - God is love. And to know God is to know love. God's love is shown to us through the ultimate sacrifice- sending his only Son as the atonement for our sins. If God is in us, His love is in us. (That always stops me in my tracks. We have Gods perfect and powerful love inside of us- at our disposal to use to serve others.)  But with power comes great responsibility. Therefore, the way that we treat people is a reflection of God's love. Our actions can be a positive or negative testament of Gods love and our actions are a choice. We should choose to love without borders or limits. We should love sacrificially.  When I think about who and how I should love, I try to look in mirror first. I think of my attitude, my actions, my past and then remind myself that God loves me unconditionally, despite all of the hiccups along the way. God chooses to love me every day-even when it's hard (...which is daily). I also think of how he chose to show His love for me - he sacrificed His Son so I might live. That wasn't an easy sacrifice. That wasn't the spare change in the cup holder for the homeless man on the corner - it was thought out, it hurt, it required so much of Him. He loves BIG. And because God first loved me, I ought to love others in that same manner. I fall short on a daily basis, but the ultimate goal is to love like God. To love Big. To love all. To spread the love that I have been to blessed to receive. 

Clinic 4: Ankazomiriotra

Thursday 10/27 - Woke up to 6am Zumba with Yolanda that turned into Zumba with the Malagasy instructor... looks like we talked too much about it yesterday bc everyone wanted to come today! Eleanor apparently takes Zumba every Weds and Sat and told her instructor to come so he brought his book box and took over the class! He was doing high kicks and twirls like crazy. Round 2 is tomorrow... I need to start to prepare now!

Our clinic today was 75km west of Antsirabe into "the bush" (Malagasy for super rural). The drive was absolutely incredible and you could watch as the terraced mountains rose up around us and the number of towns drastically declined. The further from the city we went, the worse the road became. We even passed by an area where the road simply was gone from a landslide so there was only one lane left and no guardrail. The quality of housing also declined and the majority of houses were made from mud and thatched roofs. The further we got, the poorer it became and we knew this was going to be a very interesting clinic. 

 

About half way to our clinic, we started seeing tons of people walking on the side of the road and Pastor Honey said it must be market day in the town. Apparently there's a big market in town every Thurs for people to come in to buy and sell groceries and supplies. We saw people walking from 10+ km in both directions to get to town. The market was packed and people were trading goods and services. It was a bright colorful chaos. 

We arrived at the church after 1.5hr drive to a huge crowd of people waiting. The church really stood out from all the mud and straw houses nearby bc it is a beautiful brick building with glass windows and steel accents. It will definitely weather any storm and keep the people safe! We had a devotion to bless the clinic and then started seeing patients! 

So the drive was already making me get a little choked up at the level of poverty, but once we saw the people coming through the front door, my heart exploded for them. These wonderful people have absolutely nothing and are happy as can be and love life! Their complaints were so minor, like lower back pain, joint pain, and headache. The kids were overall pretty healthy and were so smiley!! One thing I love about the people here is how much they smile! Medical tourism is clearly not in Madagascar and the people are still excited to have visitors come in and provide necessary services to them. 

One patient was so glad we came and started crying tears of joy when I gave her a Polaroid picture of herself. She kept saying how she wished she had brought vegetables from her garden to give to us as a thank you for coming to serve. Again, they have nothing and are willing to give up everything! We can all take a life cue from them. 

We saw over 470 patients today before having to pack up and head home at 2pm. We had to leave early bc there have been reports of bandits coming in and stealing the zibu so we needed to be on the road with plenty of buffer time to be back in safe areas before sunset. It was so hard to say goodbye to the families we met today. I would give anything to come back to this village and spend more time serving the people in whatever form is needed! 

Our drive home was a sleepy one after a hot day. We did make a very cool stop on our way home at the Royal Fig Tree. This tree is absolutely gorgeous and signifies a king used to live there. It's considered good luck to touch the tree so obviously we had to stop and take pictures posing with the awesome roots!

As we left the tree, the rain slowly crept in from the north and soon we were in a full blown storm! People were running to take cover and so it was like playing chicken with way too many moving objects in addition to not being able to see! The cutest part of the rain was seeing all the kids coming home from school... they were running full steam ahead to get home but had the biggest grins on their faces the whole time! 

 

After dinner we had our last pill packing party, which ended up looking more like a meth lab thanks to the Malagasy ziplock bags. We ran out of actual ziplock bags so Damoina had "ziplock bags" made for us. They are two sheets of plastic sealed using candle heat and we had to friction open the top and then candle seal the open side once we put in the meds. Gotta love learning new tricks...

 

Daily devotion:  2 Corinthians 12:9

“And he hath said unto me, My grace is sufficient for thee: for my power is made perfect in weakness. Most gladly therefore will I rather glory in my weaknesses, that the power of Christ may rest upon me.” -2 Corinthians 12:9

This is the scripture that the local church had painted on their wall above the alter. I think it is so fascinating that each church adopts a specific bible verse as their own. Knowing the people we treated today it makes sense to emphasize Gods ability to bring up the weak 

Clinic 3: Masinandraina

Weds 10/26 - What better way to start off the morning than a 30min Zumba class with Yolanda! Meg, JillRae, and I met her out on the lawn by the guest house which has a beautiful view of the city and immediately started dancing to Pit Bull. To say that the Malagasy people were confused by our actions were an understatement. I tried to wave in a couple girls to join but they preferred to stare at the crazy white girls attempting to imitate a trained Hispanic dancer. 

After our little exercise routine, we quickly changed and met the group at the dispensary for morning devotion. Every morning at 7:10am there is a morning service led by the pastor where the Malagasy people sing hymns and share the gospel. Unfortunately we didn't have a translator so instead Jill made friends with a family and started reading alongside of them. She reported back to the group that the pastor was reading Acts 16... the same passage that we started out trip with! He read the whole chapter, including Lydia and her purple goods, which has become a symbol of the trip. This is just one of many "God things" that confirms we are supposed to be here.  

Our clinic today was just west outside of Antsirabe in a small drive-thru town. It looked like one of the many towns we roar through on our way to get to a destination so it was nice to actually stop of meet the locals. 

I was paired up with John (ER PA) today in our tiny 1 room house. We have been spoiled the past couple of days with these large churches! Now we are back to reality... so the nurses and providers were in this one tiny house and then the pharmacy was set up down the road in another small house. Our group is amazing though and not a single person complained about the new environment. We are here to serve and therefore we adapt to whatever situation we are given.  

We saw around 400 patients today in our half day clinic and are starting to run out of medications in the pharmacy! Hopefully we have more back at the hospital to use for the next couple of days....

Megan was a rockstar today and was working with Yolanda (Ortho PA) so she took the Polaroid camera and was giving out polaroids to all of the patients. After we finished seeing patients the madness erupted... a true Polaroid frenzy occurred midway between the doctors area and the pharmacy. I stopped to take a picture of a family in their street side farmers market and next thing I know I was surrounded by 20+ children all vying for the next magic picture to come out of the camera! After a roll and a half of film I attempted my escape from mayhem and instead became the pide piper with children blindly crossing the street to get to the camera. Apparently this is not the best idea since it is "one of those drive-thru towns" and if any child got hurt crossing the street I would be liable to pay all the medical bills soooo the Polaroid camera went away bc my debt doesn't need any extra help growing! 

     

We packed up the pharmacy and headed back to town. The rest of the afternoon was free time so some people went shopping while others took naps. I was planning on taking a nap (these are longgg tiring days) but instead Yolanda burst into our room and said there were 2 surgeries about to go on! Meg and I quickly changed into our scrubs and ran to the OR. 

The first surgery was a high risk neonate surgery so we all watched while 3 surgeons operated on a 4 day old boy born without an anus. He presented today with a HUGE distended belly because he has been eating for 4 days but unable to pass stool. The doctors were very worried since it was a high risk surgery but the plan was to create a loop colostomy that could be reversed in 3yrs. However when Dr Harison opened the belly, he found the cecum and appendix in the LUQ instead of RLQ indicating the baby also has a malrotation. So Dr Harison closed his initial incision and made a new one of the right side to hopefully find the transverse colon. Instead he found no colon at all... after more digging around, he discovered the baby only had a cecum (the first part of the colon) and the rest had not developed. It was a very distended blind pouch. The surgeons were able to make the loop ostomy but this baby is not out of the woods yet. There are so many complications that can occur with ostomies, especially in 3rd / 4th world countries, but even in the USA, the baby would need to be carefully followed for nutritional deficiencies and delayed growth. Please keep this baby boy in your prayers!

Our next surgery was an Ortho trauma surgery that Yolanda was able to first assist with. So she scrubbed in and helped reduce and plate a displaced comminuted femur fracture (aka 3+ pieces) from a motorcycle accident. The tools used were like the tools in my dads work station, including the yellow POWER DRILL that was dirty (not sterile) and stored in a Tupperware container. Ortho tools in the US are equally barbaric but at least they're sterile!

It is very interesting to see the sterile technique used here in comparison to what Meg and I learned at Northside Surgery. Oh the stories we will have from the next 2 weeks after the team leaves as we scrub into surgeries and round on patients. For example today one of the other surgeons poured himself a cup of coffee and meandered into the OR to see how it was going. Then he proceeded to spill some coffee on the patients pillow... definitely sterile practices. 

As Damoina said the first day, this is African medicine. The electricity is unreliable (it was in and out all afternoon) and everything is a makeshift fit. I'm glad to have learned the "proper technique" back home during my surgery rotation but I'm equally excited to learn how to think outside the box and make do with what resources we have. 

 

Daily devotion: Acts 16 (again...)

“And on the sabbath day we went forth without the gate by a river side, where we supposed there was a place of prayer; and we sat down, and spake unto the women that were come together. And a certain woman named Lydia, a seller of purple, of the city of Thyatira, one that worshipped God, heard us: whose heart the Lord opened to give heed unto the things which were spoken by Paul. And when she was baptized, and her household, she besought us, saying, If ye have judged me to be faithful to the Lord, come into my house, and abide there. And she constrained us.” -Acts 16:13-15

  The first day Jill read us Acts 16:9-11 and while Pastor Mike was talking she kept scanning and came across Lydia, a seller of purple. Purple had already come up several times that day and so it's now a thing for the trip. So how amazing that the devotion today including Lydia and her purple goods. It's a reminder that we need to keep our focus on the Lord as we interact with these patients. It's half way through the week and everyone is getting a little tired. It's easy to start cutting corners and not treating patients as they should. But you never know when you will be the one to share Christ's love to a non-believer and forever change their life. God works in mysterious ways and He is definitely leaving us breadcrumbs to follow while here in Madagascar. Please continue to pray for our team as we enter the 2nd half of the week and let us show the same compassion and mercy to the first and last patient of the day.