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Darling country children playing their homemade mud game!!
Sharing the road with these guys!!
Don't you just love these country women?!?
Doing what I do best...accompanying missionaries to the clinic...In this case...an ingrown toenail.
The local bike ferry...it's one way to get your bike across the river!
Drying the dyed fibers for basket making...sure makes for a colorful countryside!
Aren't these pretty? I bought a large basket for our laundry...couldn't resist!
General mode of transporting goods!!
My basket! I won't be carrying it like this any time soon!
Another ox cart to share the main highway to Antsirabe with.
Just loved this scene...
A Glimpse into Healthcare in Madagascar
This past week and a half have been filled with visits to the Doctor for one missionary issue or another. It has been really busy! As I mentioned before, we are blessed to have a wonderful resource in our Doctor Lara who is also a missionary for his church, The Seventh-Day Adventist church. He speaks excellent English (he’s from Argentina, originally), and is an American Board Certified surgeon. So we do feel that he is definitely a blessing to us, and me in particular, since I’m the one who has to figure healthcare things out! ha! Anyway, the clinic is not too far away, but depending on traffic it can take up to 40 minutes to get there. We try and time it at less busy times, if possible, in which case we can get there in 15 minutes. We drive the missionaries there and then wait to be seen. This is the challenging part…the waiting. It’s pretty much first come, first serve…so one never knows how long it will be. Today’s visit was 3 hours (which included a procedure, but really?!?) I’m grateful for my l-Pad because I can read or study scriptures as the case may be—or plan lessons, whatever. It definitely comes in handy! (I thank Steve regularly for this Christmas gift that I use every single day!). It is winter here right now, and as such, it is pretty cold. I was not prepared to be so cold; especially as I wait for hours in an unheated clinic. I’m not aware of anywhere in Madagascar that has any kind of central heat….and for some reason, the Malagasies LOVE to keep the windows and doors open, despite the cold air! I’m pretty much cold all of the time. So…when I’ve spent many hours in the clinic waiting, I do so with freezing feet and hands. Now…the temperature is about 55-60 during the day, which doesn’t sound so cold, but for some reason, it IS!! (perhaps it’s the humidity…) At night it drops into the mid to low 40’s. We do have a small electric heater in our apartment which helps, but the heat doesn’t extend as far as we need it to…but I’ll not complain…I’m grateful for it! (Sometimes I just bundle up in my robe and climb into bed with my blanket on and study in bed from 7:00 PM on—or I’ll admit, sometimes it’s been as early as 6:30!) But I digress (as usual!)…Anyway…Steve has taken to staying in the car while I help the missionaries at the clinic. Believe it or not, it’s warmer out there. He studies there or sometimes takes a little nap! I feel sorry for him to have to just wait for us…I wish I were brave enough to drive here, but it’s NOT happening any time soon!! We’ve had an elder needing to have his toenail removed for an extensive ingrown toenail; one with a swollen knee, another with a hurt back from playing basketball about 4 months ago (I had tried everything I knew, but nothing would bring sustained relief…we’re finally getting an x-ray)a; a senior missionary with an inflamed nerve in his neck; and a senior sister who wanted to get a small skin lesion removed. There is a Malagasy elder I am worried about, for whom we need to get a biopsy done on a lump in his neck….so each day brings new issues. I pray for each one of them and for the missionaries as a whole.
If a missionary needs to have an x-ray, we have to go clear across town to get it; about a 40-60 minute drive, then drive back to the clinic at a later date for treatment. Then we wait again. If a biopsy is done, we then have to drive the sample to the Pasteur Institute for testing. The doctor hands you the resected tissue in a little bottle filled with formaldehyde and you’re on your own. We take it to the institute (which is pretty clean and a nicer facility), wait our turn in line to process the order and pay for it (everything is paid for in cash at the time of service). Then we hand carry it down to another part of the clinic to the receiving area and have the specimen tagged and entered. I believe the specimens are actually sent to Paris for testing. They give you a date for the report results (which in this case is in one month…one whole month to get the biopsy results!) and then we have to go back in person to get it. Everything is a process here…nothing is very easy or quick…one must have, or develop (as the case may be), PATIENCE!
The sister who had a skin lesion removed said it was done in the surgical suite of the Adventist Clinic (think clean, but 1960’s era). When they got her positioned, they had her put her hand out on flat metal plate with “goop” on it and wires sticking out of it. I immediately knew it was some sort of grounding pad to protect her from the electrical current of the cautery machine! I was stunned, but we got the giggles just knowing this is best Madagascar has to offer!
The day we went to visit a friend who’s baby got dropped on his head and he was in the neuro-pediatric unit at the University hospital, I really had my eyes opened. That hospital is very old and not very clean. In the room he was in, there 12 children. They all have to bring their own bedding and supplies, etc. There was no monitoring equipment of any kind. There were a few with IV’s, but other than that, you would never know it was a neuro unit. The beds were the old 1940’s style metal beds that lay flat only. You must pay for all your supplies up front, including dressings and syringes..anything you might need. One parent was trying to figure out some sort of IV board to put the baby’s arm on…they finally folded a piece of cardboard in a fashion and taped it in place. At one point one of the IV’s had stopped and the nurse wanted to use a syringe to irrigate it to get it started again. Everyone in the room asked each other if anyone had a syringe. One child had one in his drawer so his mother gave it to the other mother (don’t worry it was new—although at this point I wouldn't have been surprised if it was not…). They watch out for each other, though, and that was a sweet gesture. They must bring in all their own food as well. I must admit it was heart wrenching to consider their circumstances. One child had been hit by a car, a hit and run, and he was lying there semi-conscious. We expressed our concern to his father. Then his father followed us outside and asked us to give him money to pay his hospital bill. Once again, it is so difficult to not reach in your pocket and help. But we have been advised many times not to give money directly (there is so much need!)… but I know if we had, we would have had ALL the parents in that unit asking for money…none can afford things, even if they are very inexpensive compared with US standards.
A couple of months back, there was a Malagasy returned sister missionary (she served in Africa) whom the church asked me to check with as she had been diagnosed with TB on her mission. They wanted to make sure she had all the medications she needed and that she was taking them accordingly. She lives in Antsirabe (3+ hours south of me). I had sent the sister missionaries to touch bases with her. She was doing well at the the time. Then a couple of weeks ago she was really sick and getting worse. The missionaries were worried about her; they thought it might be related to her TB. I called the church and asked for special permission to have her seen by a doctor. As she was not in our mission as a missionary, it was a bit complicated. But I finally got permission. We sent her to the doctor and the doctor sent her to the TB speciality clinic in her area. They did some testing and said she was free of the TB and didn’t need to take the meds any longer. But the bad news was she had typhoid! They gave her some antibiotics and other meds. The senior couple in Antsirabe were assisting us at this point. When they took her home, they were pretty concerned. They reported that she lived in a one room, rather ramshackle home, with her parents and 7 siblings. This family did their cooking over a charcoal stove inside their house (many will do it outside, or in another room), and that the room was black with soot, etc. They reported the family is very poor, but very kind. I heard a few days later that the sister was improving and feeling very much better. I was so grateful we were able to have her seen…to be TB free and to have avoided a crises with the typhoid as it can be deadly! But I couldn’t help but wonder what her future will hold…such poor living conditions and such poverty does not bode well for a long life; but such is the plight of so many. Oh, by the way…the bill for the medical consult, the lab and x-ray and medications, totaled about $10 US dollars! That is so inexpensive for us, but to her, it would have been impossible. If we had not stepped in to get special permission to pay her medical bill, she would have gone untreated with potentially disastrous results.
Update on the elder with the neck mass…the doctor decided to have him get a CT scan before we went ahead with the biopsy. The results showed that the mass had reduced in size from the original X-ray, but the 20+ nodes were still there. When we went back to the doctor with the results of the scan, he read one last lab report that indicated that the elder had Toxoplasmosis—a parasitic infection that causes swollen lymph nodes (especially in the neck). This is the parasite that comes from cat feces. Yeah…there’s never a dull moment here! Anyway, they decided not to do the biopsy and to treat for this parasite first. The neck mass turned out not to be one lump, but a few lymph nodes swollen together, but it had already started to respond to some antibiotics. So the doctor feels he does not have lymphoma…phew…I surely hope that this is the case! Gratefully e has no other symptoms, so we will just wait and see how he responds to treatment.
Last week we met with the director of a local air-evac team from Tana. We were surprised to know they had such a company and that they even have their own plane. We have been trying to get to know all of the best local care providers in case of an accident or incident with one of our missionaries even in the remote places. We found that nearly all of the areas where the missionaries serve is accessible by plane, except for one or two cities that are deeper in the interior. In which case they would need to get to the nearest town with an airport and have this company go in and bring them to Tana. We continue to work on having contingency plans for medical emergencies for young missionaries and for us older folks as well!
Steve has done two firesides now for returned missionaries on the principles of self-reliance, growing wealth and business management. It’s mostly an introductory presentation to get them thinking longer term. Most Malagasies spend everything they make, living day to day, and are not preparing for emergencies or for the future. The concept of simply saving something (no matter how small) consistently, is quite unheard of. Throwing in the idea of compounding interest, is beyond their comprehension, but Steve has done a good job of giving simple examples (again to get them thinking). We have such hope for these young people. They are so sweet and we know they are the future of the church here. We so want to help them to elevate themselves out of poverty and out of cultural traditions that prevent growth.
Another thing we have started to do is to teach an institute class every other week. It is on preparing for a celestial marriage. Again, when we meet with these young people, we are so touched by their earnest desires to live a Christ centered life. They are so wonderful and we feel the spirit when we are with them.
We have the joy of being in Antsirabe again this weekend. Steve has been working with a local bike repairman to establish a bike maintenance program on the missionary bikes. They are always breaking down! We know the rough roads and conditions they are being ridden on, but we would like to try this approach with more preventative maintenance to see if we can extend the life of the bikes.
The church is really growing here in Antsirabe and they have 3 very large branches in this town. The members are so welcoming and faithful…we enjoyed attending church here. The hope is that this area and the other two surrounding branches will be able to become a Stake soon. There are plans to build a new church building adjacent to the rented building they meet in now. So, it’s progressing.
We are anxiously engaged here, and we love that. We love being busy and pray always that we can make a difference for these good people. We know our Heavenly Father loves His children here in Madagascar and has a desire for their success and happiness in this life as well as in the hope of eternal life to come. We are blessed by our association with them. We also desire to help the missionaries stay healthy and well, and to support them when they do become ill. Our days are filled with purpose!
We send our love, as always, to each of you. God bless you!!
Steve and Michele
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