Clinic 2: Antsontany

Tues 10/25 - Our morning began like all the others with coffee and PANCE questions from John... John is an ER PA on our trip who also happens to be the founder and owner of CME4Life which is an amazing PANCE/PANRE review course. He teaches PAs how to learn medical knowledge for life and not just for a test. He does this by simplifying things into pneumonics and flow charts to understand the topic. We are so blessed to have him on our trip as a fabulous resource in addition to JillRae and the other incredibly smart providers. But sometimes getting questioned on a topic we told him we don't know well at 7am is a littttttle too early!

Regardless, around 8am we packed up the vans again and headed north to another small village just off the main paved road. The off-roading time was shorter but a lot scarier since this "road" was basically small canyon we straddled. We could've gotten majorly stuck at any point! 

When we pulled up to the church, the first thing I noticed was ALL OF THE KIDS! Seriously though... the niños were everywhere and definitely out numbered the adults. We had a morning devotion with the local pastor and prayed over the clinic for healing hands and patient hearts. 

Today I worked with Dr Joel and our interpreter was Eleanor (main English teacher). We worked so well together and lunch came before we knew it. The most interesting patient Joel and I saw was an 18mo boy who still couldn't walk due to cerebral palsy. The Mom didn't understand what was going on so we had to really take some time to explain that her son will probably not ever walk but PT moves could help with tone and muscle strength. 

As a whole, we had some very interesting patients come through the clinic today... JillRae dx a 19yo with Hanson's disease (Leprosy), Yolanda dx a 22yo with TB, and Dr Harrison dx two different kids with severe cases of mycobacterium. One of the kids had thick lichenified scales covering both of his legs from toes to knees and it was spreading to his trunk. The other kid had a 10cm circle over his umbilicus that was equally dry and lichenified. This dx is apparently pretty rare unless you live in the bush. Both of those kids traveled pretty far to get to the clinic today and I'm so glad they did!! 

Final count today was 465 patients and 1122 prescriptions handed out. Several people walked 10+ km to get to us bc they heard the clinic advertised on the radio. Unfortunately we were not able to see all of the patients, so Dr Harrison, Scarlet, Meg and I will be going back on Nov 2nd to finish the work we started today! 

One thing that JillRae stressed during our reflection today was to remember these patients are more than a number. We are here to serve the people - to listen and to touch. Take time to talk with the patient and get to know them as a person and not only about their diagnosis! It is the difference between a good provider and a great provider. 

Polaroid project has really taken off!! I've never seen people so shocked at the magic of the printing camera box and excited for their face to be on the paper! 

After the clinic we went to a gemstone market next to the hospital and the Zibu horn craft store down the road. Both were very interesting to learn about and then try to barter in a language I don't speak... may or may not have tried speaking Spanish to them but it didn't work out so well... 

Another great (long) day! More fantastic learning opportunities and chances to make a difference in someone else's life. One fun thing I learned today with church mission events is that they play music on loud speakers to attract surrounding villagers to come to the church to investigate what is going on. The music was blasting all day and so many new faces came to the church and were able to meet the clergy and hopefully find a community at the church! 

We finished off the day with wine-thirty at our place where everyone came over for wine, wifi, and worship songs played by Jill on the guitar. It was everything and we stayed up wayyyyy too late. Yolanda still wants to do Zumba tomorrow at 6am so hopefully I'll make it but no promises...

 

Daily devotion: Romans 12:12

“Rejoicing in hope; patient in tribulation; continuing stedfastly in prayer;” -Romans 12:12 

This bible verse was painted above the altar at the church. The entire church is under renovation but the pastor made sure that part stayed visible. The words in Romans could not be more true in our mission here. We rejoice in the hope of spreading the gospel by opening the door with medicine. We remain patient in times where it seems too overwhelming to continue- like when you have 250+ patients to get to after lunch and you only have 2 hours or when you have walked 15km and have to wait all day to be seen by a doctor. We stay steadfast in prayer when you have nothing to offer a sick patient except for your love, compassion, and prayer. Please continue to pray for our patients who are traveling far and wide seeking medical care. Let us not only nourish their physical bodies but also their spiritual thirst. 

Clinic 1: Loharano

Mon 10/24 - Our first day of the mobile clinic was in a small town called Loharano (meaning "head of water") that was 45min north of Antsirabe. This town was actually a repeat town from the most recent medical mission group two weeks ago bc they were unable to see all of the patients in one day and we came back to see the rest! The town was very rural and we had to take mostly bumpy dirt roads to get there... talk about car sick! But it felt like we were in an NatGeo magazine with all the small villages, local people smiling and waving, and workers in the fields. 

When we arrived at the church, the courtyard was overflowing with patients to be seen. Last time the group game, they saw over 500 patients and there was probably another 500 more waiting to be seen. This is because we were deep in the bush where not many people travel so  people come from far away to see the American doctors. 

We immediately went inside the church and began rearranging the pews to set up our clinic. The patients entered from the side door into triage before being sent to see a provider and then onto pharmacy. There were 3 Malagasy providers (including Dr Harrison) and then 5 American providers.

Before the clinic started, the local pastor began with a devotion and the scripture he chose was especially meaningful to Jill, Meg and I. He read Luke 10:33-34 about the Good Samaritan and related it to us. He thanked us for giving up our time and money to serve his community and explained how with medical mission work like ours it raises church attendance and truly brings Christ into the lime light. To end the devotion, the entire courtyard erupted in Blessed Assurance followed by the Lords Prayer which we could all join in with the English version! Faith truly transcends all cultures and languages :)

I was working with Chesley, an internal med PA, and we saw some very interesting cases. The first case of the day was intra-biliary schistosomiasis (aka a parasite traveled from the stomach into the GB/liver) that we sent to the hospital for treatment. Next we had a lady with severe anxiety about bandits who have been raiding her community. We also saw tons of kids and the two standout ones were a 6yo deaf mute who had never received any therapy and a 3yo who stepped in a fire and had 2nd degree burns on his foot. We had to debride the wound using a pocket knife and water since we had no numbing medicine. 

By far the coolest patient of the day was a rare diagnosis THAT I RECOGNIZED!! And the only reason I knew it was from my derm rotation I just finished where we had a patient with Klippel-Traunay-Weber syndrome. My derm doc said he had only seen in it once before back in his residency. So this lady today came in for back pain and while we were talking I noticed her right hand was much larger than her right. I asked her to hold out her hands in front of her to check for an arm length discrepancy. Then I asked if she had port wine stains all over the right side of her body and she said yes. Lastly I asked if her right leg was swollen with varicose veins AND SHE SAID YES! She was born like this and it's a completely benign but disfiguring disease. So I was able to educate her on her condition in addition to helping her back pain!!

We saw over 600 patients today and filled 1745 prescriptions! We worked up until dusk and saw every last patient there. 

The kids and adults loved the Polaroid project and are SO HAPPY to have a picture to keep. The smiles on their faces told the whole story and the translator confirmed that most people don't have any pictures of themselves. Thank you again to everyone who donated!! You have left a part of yourself here in Madagascar!

 We didn't finish the clinic until it was almost dusk so by the time we loaded up the vans and left, the sun was setting. It was the perfect way to end a perfect day! God lit our path with a gorgeous sunset until we got to the paved road. It was as if He was smiling down on us after a long day of being His Good Samaritan to the Malagasy people. I honestly can not wait to see what the rest of the week brings!

 

Daily devotion: Luke 10: 33-44, 37

“But a certain Samaritan, as he journeyed, came where he was: and when he saw him, he had compassion on him, And went to him, and bound up his wounds, pouring in oil and wine, and set him on his own beast, and brought him to an inn, and took care of him. “Which now of these three, thinkest thou, was neighbour unto him that fell among the thieves? And he said, He that shewed mercy on him. Then said Jesus unto him, Go, and do thou likewise.” -Luke 10:33-34, 36-37

The Malagasy pastor explained that the Good Samaritan shows compassion 3 ways: 

1. He loves all
2. He does not discriminate 
3. He helps all people

We are called to be like the Good Samaritan. We are called to love everyone without discrimination and to help all people as best as we can. The without discrimination part is what really sticks out to me bc all people deserve the same respect and compassion. Our mission is to be the Good Samaritan for the Malagasy people. We accept all with open arms, treat each patient with the same respect, and share love and compassion with them. Pray that we may channel the Good Samaritan as we meet each and every patient today and always. 

A F R I C A

Sunday 10/23 - First day in AFRICA! Woke up this morning to the most beautiful day! Blue skies, 70 degrees, and all the bright colors of Tana staring back at us. We met downstairs in the hotel for breakfast at 9:30am and hit the road by 10am to make the 3hr journey (160km) to Antsirabe. 

  Side note: In Oct/Nov, several awesome seasonal changes occur. The Jacaranda tree blossoms to a beautiful purple color, mangos are in season, and baby lemurs are born. We were lucky to see a ton of beautiful Jacaranda trees on our drive! So we just have mangos to eat and baby lemurs to cuddle....

We drove out of the capital and made our way south, passing many small villages and lots of farmland. All I can say is Madagascar is one of a kind... I felt like I was in Asia with all the rice patties, in South America with the bright colors of the Sunday Market, in Colorado with the windy roads and overall mountain landscape, and in the Deep South as everyone was letting out of Sunday church services wearing their big hats and nicest dresses. 

We passed by women doing laundry in the mucky rivers while the men fished nearby. We saw kids playing soccer, foosball (there was at least 1 in every town), or helping out in the fields. Fun fact: over 50% of the population is under 15yo. There are kids everywhere! We saw families walking on paths that are kilometers from the next closest village while balancing goods on their heads. We saw lots of poverty but we also saw structure. Madagascar has a great brick making industry so most of the houses have four sturdy walls and a straw roof. Some have brightly painted walls or doors while others are slowly cracking from settling over the years. 

Finally we made it to the Lutheran hospital compound in Antsirabe and it is something! I've worked in 3rd world hospitals before in Peru but this one is very unique. It sits in the middle of the city inside a gated fence. The main hospital is in a 2-story white building that looks like an old house and was probably build over 100yrs ago. The rest of the medical areas have been built around the main building to turn the hospital into a "full service medical center". The pediatric unit is to the right and the triage, dispensary and OR are in buildings on the left. The triage area is actually made out of 2 shipping containers that were sent over several years ago with supplies. A separate dental clinic and eyeglass clinic are also on the property in addition to Dr Harrison's house and the guest house.

Dr Harrison and his wife Damoina live in a cute yellow house at the front of the property. The house has a separate apartment on the ground floor so that is where Megan, Jill, Scarlet, Joel and I are staying. The rest of the crew is in the guest house near the back of the property. As soon as we got to the guest house, we were served an amazing lunch! It was chicken and rice and fries and veggies and mac and cheese with ice cream for desert... definitely not gonna lose weight on this trip! 

After lunch we were given time to settle in before getting a tour of the hospital. And this is when the flexibility kicked in. The housekeeper had locked up the basement apartment where we were supposed to stay and didn't leave the key anywhere so we couldn't get in. While Domoina went to track down the key, we went back to the guest house to find a bunch of kids outside playing. So what did we do? I channeled my inner Megan Thornton and Jill and I started playing soccer with them. We started with a game of keep away that we explained using pointing and random sounds since no one knew Malagasy. Then it progressed into a full court scrimmage of boys vs girls. Meg was in the goal and we were doing great until all the girls slowly quit and it was just Meg and I vs the boys. To say it was unfair was putting it mild. So I recruited the older guys (16yo+) who had been sitting and watching to come play on our team! They reluctantly joined but once they did, the game was a lot more interesting and way more fun!! 

Dr Harison was no where to be found for the hospital tour so instead we began our unpacking and sorting the 17 bags of donations into pharmacy, nursing, and hospital supplies. Hospital supplies were taken to Dr H's office for storage. Nursing organized their stuff for the clinics this week. And pharmacy took center stage with a full blown packing party. We counted and filled countless baggies with prescriptions to hand out. By 8pm we had finished and then had an amazing dinner by flashlight. We had zibu (type of beef) with veggie lo mein and rice with fresh fruit for desert! 

Why did we eat by flashlight you ask? It's because earlier that evening we couldn't find Dr H bc he had been pulled away to work on the broken generator... apparently the hospital had no power all day and the men couldn't fix it! There is only one generator for the entire compound so it looks like we would be living in the dark tonight! Domoina and Dr H kept apologizing profusely but we told them not to worry. We all had flashlights and head lamps so the show would go on! But no power = no lights in the OR for the emergency c-section of a baby boy with cleft palate that came thru. No lights in the hospital floor where sick patients were. No lights in the dispensary where the pharmacists were supposed to electronically record the meds handed out.  Instead the hospital began to glow by candlelight as night fell over us. As Damoina said, this is African medicine. 

 

Daily devotion: Great is Thy Faithfulness hymn

Even when things are dark and troubled, God's faithfulness and mercy never fails. His grace and loving care do not change. Remember this when times get tough and patience grows thin. Please pray for the people who travel to see us tomorrow in clinic. Let us be able to serve with the same enthusiasm from the first patient to the last. 

18hrs of flight time later...

Finally able to post the past couple days now that the electricity is back on and we have Internet!!

18hrs in a plane with Meg and JillRae means lots of movies, sleeping, laughing, and spilling food and drinks. We took turns laying on each other and got max 4hrs of sleep. When we flew into Paris it was completely fogged in - as in a blind landing - so sadly we didn't get any Eiffel Tower views but we did listen to Lauren Chisholm and tried the macaroons! Yum! 

Our journey continued with the 10hr flight into the Southern Hemisphere. We flew down the coast of Italy and entered Africa over Alexandria in Egypt. The coolest part was following the Nile River all the way south and then Meg got to say hi to Mt Killi when we flew over that too! Our flight landed around midnight on the ONLY runway at the MAD international airport. The airbus parked on the open tarmac and we debarked by stairs into the open air building. Customs took no time but our bags took over 2hrs to get to us so we didn't leave the airport until 3am. Made it to the hotel by 330 and passed out at 4am (after our last hot shower for over 3 weeks). And yes, all of the beds have mosquito nests over them! 

 

   

Adventure Awaits

Meet the team:

• 1 doctor and 4 PAs 
• 3 nurses from CHOA
• 1 PharmD and 4 Mercer pharmacy students 
• Pastor Mike and another logistics lady
• Meg and Suze PA-S extraordinaires 

To preface this trip, I need to tell everyone how awesome Scarlet is! She is our fearless leader and this is her 50+ mission trip... So she knows what's she's doing! She negotiated a free 2nd checked bag for each of us to bring down donations and we were all asked to collect as much as possible. The Mercer PA Class of 2018 did an amazing job collecting donations during PA week and pulled together a huge box full!  Last night the team packed over 600lbs of donations into 19 suitcases. Talk about amazing!! It was like a game of Tetris to get every bag right at 50lbs! Then today we loaded up all of the luggage (36 suitcases total!) into a trailer and headed to the airport. It took a mere hour to check everyone in but we did it and not a single bag was overweight! 

And as everyone knows, there had to be that one "odd donation" that won't fit in a suitcase and this time it was a wheelchair and crutches. So what did we do? Naturally we made Pastor Mike fake a hip injury that required him to take a "personal wheelchair" through security and onto the plane. He was a champ and even let Meg try to pop a wheelie while pushing him in the middle of the concourse! A few concerned glances may have been thrown our way but they didn't know he's surrounded by healthcare professionals. 

The journey has officially begun and I know there are many good things to come! I can't wait to see what God has in store for us and hopefully we will be able to make a meaningful impact on the people of Malagasy. Au revoir from our layover in Paris!  

Daily devotion:

“And a vision appeared to Paul in the night: There was a man of Macedonia standing, beseeching him, and saying, Come over into Macedonia, and help us. And when he had seen the vision, straightway we sought to go forth into Macedonia, concluding that God had called us to preach the gospel unto them.” Acts 16:9-10

And over to Madagascar we head to serve the Lord as He sees fit. We don't always know why things happen as they do, but we must remain flexible and know there is a greater plan. As Pastor Mike said this morning, we do not go serve for the bragging rights, for the escape from reality, or for the love of travel. We go serve to spread the Gospel by way of medicine. And we must remember this when worldly reasons try to take precedence. So please continue to pray for us that we may remember to keep Christ at the center of our mission in Madagascar. 

The Main Players + Deets

Megan and I are headed to the airport our series of flights tonight! For some odd reason there aren't any direct flights to Madagascar... so instead we are flying overnight to Paris and then onto Antananarivo (now known as Tana for short). We land 11pm tomorrow and the adventure begins!

We will be based in Antsirabe at the local Lutheran Hospital (antsirabelutheranhospital.org) for our entire stay. The first week is with the Mercer Pharmacy students who travel every year to do mission work for a week. We will be going out to surrounding villages (1-2hrs away) each day to set up mobile clinics. Scarlet (lady in charge) told us to expect about 500-600 patients/day x5-6 days!! At the end of the week, the pharmacy students and JillRae (our professor) head back to the States and it'll just be Meg, Scarlet and I left to play with lemurs and I guess also do medical work:) We will be working with Dr. Harrison (medical director & head surgeon at hospital) and a fellow ER doc who speaks English for the rest of our time in country!   Which reminds me... key details about Madagascar

• Official language: French --> which means no one speaks it... so we will be learning Malagasy
• It is a 4th world country... To qualify, one must be one of the following:
  1. Sub-populations socially excluded from global society
  2. Hunter-gatherer, nomadic, pastoral, and some subsistence farming peoples living beyond the modern industrial norm
  3. Sub-populations existing in a First World country, but with the living standards of those of a Third World, or developing country
• History: Madagascar broke off from India and migrated south to sit next to Africa so the people there are the most beautiful melting pot of Indian and African
• Size: HUUUUUGE. Note the map below for reference 

Sources: Scarlet and Wikipedia so take it as you will

 More details to come!! 

 

Welcome!

I'll be keeping everyone updated with our 3.5 week adventure to Madagascar here. Check back here for *hopefully* daily updates (wifi permitting) or if you want to subscribe to to get an email notification of the new post, click the link on the right side!

Prayers and well wishes are always welcomed!!
Susan