Friends of Mandritsara

Early history of project

Here is some of the early history of the Good News Project in Mandritsara, Madagascar.

The agreement

In 1988, Dr Bob Foster, International Director of Africa Evangelical Fellowship (AEF), made a visit to Madagascar. AEF was a missionary society which had worked in southern Africa since 1889 (first as the Cape General Mission, then as the South Africa General Mission). Dr Foster had been involved in the founding of two mission hospitals in Zambia (Mukinge and Luampa) and had then moved to Angola where he had set up the Cavango Mission Hospital. Following talks with leaders of the FFBBM (Association of Bible Baptist Churches of Madagascar), an agreement was signed for a joint evangelistic and church-planting venture, through the means of a medical outreach, in the north-west region of Madagascar.
The original vision had been for a work among the Muslim communities on the north-west coast, and the town of Antsohihy had been selected as a possible site. On a visit to Antsohihy in 1990, however, it was discovered that the Malagasy government was in the process of upgrading the government hospital there to include a new surgical block. A Catholic clinic was also found to be running there, and so it was felt that perhaps this was not the place to launch another medical work.

At that point, Dr Adrien Ralaimiarison, the Malagasy doctor chosen by FFBBM to head up their side of the project, visited the regional director of health in Mahajanga, the provincial capital. The Director of Health was enthusiastic about the proposal, but made two specific requests. Firstly he asked that the project be located in Mandritsara, then he asked that it include a surgical unit.

Why Mandritsara?

Mandritsara, Dr Adrien was told, was the most heavily populated district of the province (apart from the town of Mahajanga) with 170,000 people living in an area of 10,000 sq km. Mandritsara was also the most remote and isolated district (600km from Mahajanga) and one of the worst served medically. Patients needing surgery had to travel the 200km from Mandritsara to Antsohihy.
Further investigation showed that although the London Missionary Society had worked in Mandritsara in the 1960’s and onwards, and there were 2 FJKM (protestant church) congregations in the town, the vast majority of the villages in the district had no Christian witness of any sort. Most people were living in total ignorance of the gospel and following traditional ancestor worship.

Providence

There were a number of other striking features of this beginning. One is that the FFBBM had been particularly used among the professional classes in the capital. Because of that, there were a number of keen Christian doctors and other professionals in these churches, meaning that the work has had Malagasy Christians involved at all levels from the start.
The FFBBM also shared the vision for evangelism and church planting. When seeking where to place the project, they did not envisage a location near to existing Baptist churches, to serve the Christians there. Instead, a largely unevangelised area, several hundred miles away from the nearest Baptist church, was chosen.

In fact, in the providence of God, in between the time of the conception and implementation of the project, a small Baptist church was born in Mandritsara. At that time a number of folk in the area were taking Bible correspondence courses with EVM (Editions Vaovao Mahafaly), run by members of the Baptist churches in Antananarivo. A team of pastors came to Mandritsara to visit these correspondence course students and to hold an evangelistic campaign. The fruit of that was a small Baptist church, which came into being in about 1990. Just after that, Nirina, a Christian land surveyor, was appointed by the government to be the town’s land surveyor. Again God’s hand was at work, because this young man was from one of the Baptist congregations in Antananarivo, and a keen evangelist.

He became the leader of the small church. But God had put him there for another reason too. The agreement between AEF and FFBBM stipulated that the FFBBM was responsible to find and acquire a suitable site for the hospital of about 6 hectares. Nirina was just the man to do that, and was able to find, and negotiate to purchase, a fine piece of land about 1 mile out of town!

The team

One of the requirements of AEF, before starting a new project, was that not only should there be an agreed project, but that a team should be assembled.

David and Jane Mann, from England, had worked with AEF since 1977, first in Kwa Zulu (South Africa) and latterly in Gabon. David was a doctor with surgical experience. Because of having worked in Gabon, David & Jane spoke French. When plans for the project in Madagascar were being made, the work in Gabon was running into difficulties because of pressure from the Gabon government on the church with which AEF was working. It was decided that AEF should withdraw from Gabon at the end of 1990, thus freeing up the Manns to be sent to Madagascar. Johan and Ann Coutigny from Belgium had been scheduled to join the work in Gabon, but because of the difficulties were sent initially to Zambia. Johan was an engineer and Ann a nurse and midwife. Though native Flemish speakers, they had done their Bible training in French at Lamorlaye just outside Paris. So they were also a natural choice for the project in Madagascar – Johan to head up the construction of the new hospital. Annie McColm, an Australian lab technician who had also previously worked with AEF in Zambia, was just reapplying to the mission. With her previous experience would she be willing to consider coming to Madagascar? Indeed she would! Since Ann Coutigny had children it was evident that she would not be working full-time in the hospital. So the need for another nurse – who would eventually become hospital matron – was pressing. By January 1993, the Coutignys had already left for Madagascar, and the Manns were about to go. At just that moment, John Lubbe, director of Swiss Mission Fellowship, happened to be in London visiting one of their missionaries working among Asians in London with the Manns church. Having previously been in AEF himself in Namibia, John contacted the Manns and “popped in” for a quick cup of tea. The question was posed to John: “Does SMG have any nurses who may be interested in coming to Madagascar?” In fact there were 2 possibilities just at that moment. A few days later Beatrice Ritzmann, who had actually been thinking of South America, phoned to ask more about Madagascar. Shortly afterwards the sixth member of the team was confirmed!

On the Malagasy side, Dr Adrien and Gisele Ralaimiarison had been approached to head up the project for the Malagasy Baptists. Adrien had a good job in respiratory medicine at one of the best hospitals in Madagascar, but felt that God was calling him to leave this to take up the challenge of the new project. This meant leaving a secure salary and future for a project that had no promise of a salary or a future. It was a huge step of faith for Adrien and Gisele.

The name

It was decided to call the new work ‘Hopitaly Vaovao Mahafaly’, the Good News Hospital, or more literally, the hospital with news that makes you happy. (Vaovao is news, faly is happy, maha- is a causative prefix).

The design

It was discovered that MSAADA, an American Lutheran architectural organisation working in third world countries, had an office in Antananarivo. They were willing to draw plans for the hospital, and fees would only be payable if funding was found. In other words no money was needed ‘up front’. Charlie Whelan was the resident architect and had already had experience in Madagascar of designing hospitals and schools. He drew outline plans for the hospital development to be built in 3 phases. He used local brick and stone construction, and the designs were based on the book ‘Design for Hospital Building’ from East Africa. The challenge then was to find the funding.

The funds

Finding a large sum of money to build a hospital seemed like an immense task. It was decided to approach large funding agencies – Christian and governmental. Much time was spent in 1992 preparing submissions to funding agencies, and visiting their offices. Every request was refused. The British Overseas Development Agency (British government) in Glasgow refused because they were unable to fund any project which it felt was ‘proselytising’. TEAR Fund UK refused because they were only interested in funding community health projects, and not hospitals. A large Protestant agency in southern Germany refused, seemingly because the project was too ‘evangelical’. The European Community in Brussels refused because the project was proposed by a missionary society and not a ‘development agency’.
Several months’ efforts to raise funds produced absolutely nothing.

At that point it was decided to launch a project ‘Buy a Brick’. The overall cost of the first phase of building was divided into amounts of £25 and a leaflet was prepared asking people to buy these ‘bricks’. The leaflet was sent out to supporters of AEF and other friends and contacts. The first money which arrived in response to this was a cheque for £75 from a lady near Liverpool. She explained that her son, aged 14, had been given money for his birthday by various relatives. He had been planning what to buy with it when the leaflet ‘Buy a Brick’ came through the letter box. He decided that instead of buying something for himself he would like to send the money to buy some bricks. He bought the first three. When the cheque arrived, it was as if God was saying ‘I don’t need any big funding agencies to do My work. I can do My work through children’. What a blessing and what an encouragement that was!

The start of building

By mid 1993, the Coutignys and Manns were in Antananarivo, engaged in learning the Malagasy language. Detailed building plans had been drawn up, four firms had submitted offers, and one had been chosen. The contract was ready to be signed. But so far only a third of the funds necessary had been raised. The missionary team was ready to sign, but since this was a joint project with the Association of Bible Baptist Churches, a meeting of the Baptist Association board was held to discuss the matter. There was some uncertainty at first whether it would be right to sign the contract when there was still so much money to be found. However, after discussion and prayer it was agreed to move forward, trusting in the Lord to supply. The Lord indeed did supply, and the project has never been in debt.

Training for Dr Adrien

When Dr Adrien was asked to be involved in the project, he had little surgical experience. It had therefore been decided to find a mission hospital in Africa where he could get some surgical training. Several doors were tried before a suitable opening was found at Nyankunde Hospital in eastern Zaire. Dr Adrien and his family arrived there at the beginning of 1992. At that time there was unrest in Zaire and many of the expatriate missionaries were leaving. Dr Adrien became an intern in the surgical department, and because there were so few doctors he was able to gain much more experience than under normal circumstances. Fortunately some of the specialists had stayed and were able to teach him.

The clinic

By late 1993, the Coutignys and Manns had moved to Mandritsara, followed in 1994 by Dr Adrien and family, Beatrice Ritzmann and Annie McColm. The first phase of construction was being undertaken by a building contractor, but progress was somewhat slow and eventually the firm pulled out before the buildings were completed. Another firm was employed to do the latter stages, and Johan Coutigny undertook some of the work, using local men to help.
Since the buildings were not ready, it was decided to rent a house in the town and open a temporary clinic. A six roomed house was found, just next to the town airstrip. Johan Coutigny and his helpers installed electricity and water. There were two consulting rooms, a treatment room, laboratory and waiting room. The sixth room was kept for a caretaker. On February 1st an opening ceremony was held, with the mayor and various town officials. On the morning of Feb 2nd the team were ready to welcome their first patients. By 7h30 only the staff were present, so the planned gospel service became a prayer meeting for patients on that first day. During the morning patients did begin to arrive, however. There were not may on that first day, but within a short time the numbers increased so much that patients were arriving in the early hours of the morning to be first in the queue.

The opening

On 25th May 1996 hundreds of people thronged the front of the new hospital at the official inauguration. A sermon, 8 speeches, cutting the ribbon and a tour of the buildings filled the morning programme. A team from the church had worked through the night to prepare the feast which followed and which included 3 cows and a vast quantity of rice! David Mann spoke on the feeding of the five thousand. He pointed out that Jesus did this miracle to show His power and to show His love for people in their need. He then spoke of how HVM had been built not with money from great organisations and wealthy benefactors, but with small amounts sent in by Sunday School children and hundreds of others – rather like the 5 loaves and 2 fishes. Thus HVM showed both the power of Jesus – to multiply humble gifts into something great, and His love – not only for their physical ailments, but also for their eternal souls. We distributed a tract that had been written for the occasion explaining why we had chosen the name Good News Hospital. We were so glad that Dr Bob Foster, whose vision 10 years ago inspired the work, was present. He brought news of another 20ft container on its way from World Medical Mission in the USA with supplies and equipment – a brand new X-ray machine (the first one was an old ex-army field X-ray unit), an ultra-sound machine, oxygen concentrator, new microscope and many other items.

The first operation

The autoclave was not yet installed, nor the operating light and other theatre equipment and we did not yet have oxygen etc. So we had not planned to start surgery for another couple of months. However, on June 10th, Ravo, wife of our administrator, went into labour. She had been unable to have a baby for the first 7 years of their marriage, but had wonderfully managed to conceive soon after responding to the Lord’s call to come to Mandritsara. The baby was only due (we thought) on July 1st so they were planning to fly to Tana on the 17th June. Ann Coutigny looked after her at home and initial progress was slow but satisfactory. However, in the second stage the baby became stuck and it became clear at 11 o’clock at night that something had to be done. We all piled into the Land Rover and drove the mile out to the hospital. We put on all the lights and promptly tripped the fuse! Fortunately we remembered how to put that right – and then we prepared for the Caesarean section. Providentially we had spent several days the previous week sorting out the boxes of instruments, sutures, gowns etc that had sat untouched for two years in the containers sent from the USA. We did not have exactly what we needed, and nothing was sterile, but we had enough to make do and we could immediately find everything. Since the autoclave was not yet functioning we had to soak all the instruments in antiseptic. We found sterile gloves and clean, though not sterile, gowns. Cloths tied round our heads made us look like the pirates of Penzance! In the absence of an operating light we were very thankful for the neon strip lights installed on the ceiling! Dr Jeannine, our Malagasy anaesthetist, had all her training in France so was not used to being without all the basic drugs and equipment! However that very day we had been discussing plans for various third-world techniques and she was able to cope. David Mann tried not to remember that the last time he had done a Caesarean section was 11 years previously! What a joy it was when Johanna was safely born and crying lustily! We expected a difficult post-operative period, but not at all! Ravo didn’t even ask for a single painkiller! All this was quite unplanned, but we felt the Lord gave it to set His seal on the work of Hopitaly Vaovao Mahafaly. A couple of days later the national Malagasy radio carried the news! It was certainly a memorable way to start! Later we discovered that the local people did not expect mother and baby to survive the operation since we had not “consecrated” the hospital with the pagan “joro” prayers. When both survived it was a real talking point among them.

The second phase

Back in 1993 an approach had been made to the European Community for help in building the hospital. Unlike the Brussels office, they did not turn down our request on the basis that we were not a development agency. “You are doing a development project, so for us you are a development agency” was their reply. Bravo for clear thinking! However the request had taken rather a long time – and it was only 4 years later by the time it was agreed to help. By this stage Phase I had been completed, so FED, the European Development Fund, agreed to fund the construction of Phase II. This included two wards, an administration block, a classroom, twenty rooms to accommodate patients’ relatives, a laundry block, central storeroom and two more staff houses. These were built in 1997 and 1998.

The death of Johan Coutigny

Johan and Ann Coutigny, from Belgium, were the first missionaries of the project and arrived in Madagascar in 1992 along with their daughter Charlotte. Johan was an engineer and his task was to oversee the building of the hospital and development of the infrastructure. In 1993 their second daughter, Judy-Lois was born in Antananarivo, and in 1997 Eveline was born while they were on leave in Belgium. In May 1998 Johan went to Antananarivo to buy supplies and to meet two retired builders arriving from Belgium who had come to help build the ward block. Johan had had a touch of flu, and on arriving back in Mandritsara developed a high fever. It rapidly developed into an overwhelming haemorrhagic viral pneumonia and to the great shock and dismay of the whole team he died on 14 May 1998.

It would be hard to underestimate the importance of the work that Johan had done. In the providence of God, Sarindra, Johan’s assistant in the maintenance department, was able to assume much of the responsibility for the building and maintenance work. Johan had been the leader of a team from the church visiting Maetsamena, a village about 40km away, each month. A small fledgling church had been planted and groups were beginning in several neighbouring villages. One of the members of the team was Flavien, the hospital carpenter. After Johan’s death he stood up in a church meeting and said publicly that he felt this ministry was of the utmost importance, and had pledged himself to God to continue the work. The work has continued and flourished to this day.

Change of Overall Leadership

October 1st saw the merger of AEF into SIM. We are deeply grateful for all AEF did in the setting up of the Mandritsara project. Given the stage of development of the project, and the gifted and committed Malagasy staff that the Lord had sent, it seemed the right moment for a shift in overall responsibility. So the Madagascar Baptist Association took overall responsibility, instead of sharing it with the mission. This was an encouraging step toward the fulfilment of the initial vision. From then on all missionaries have been seconded to work under the leadership of the Baptist Association.

Ecole Bonne Nouvelle

The school opened in 1998 with 10 children in one room. Each year an extra class has been added and now there are over 300 pupils and a staff (some part time) of 23! The school is split across two sites. The pre-school (prescolaire) has three classes for children aged 3-6. The main school has nine classes (up to age 15) in the converted house “Maison Tsiranana”, which was the home of the first president on Madagascar.

1998 Highlights

The phase 2 buildings (2 wards, admin block, classroom, laundry, central stores, 2 staff houses and 20 rooms for patients’ relatives) were completed on schedule by 31 October.
Estelle Ropp, a nurse from Mulhouse in France, arrived for a year in September.
Dr Adrien attended the Diploma in Tropical Medicine course in London.
The “Burkitt Fund” was set up to purchase anti-cancer drugs specifically for treating children with Burkitt’s lymphoma. This is a very rapidly growing tumour of the jaw (or occasionally of the abdomen and elsewhere) which usually occurs in childhood and is very sensitive to chemotherapy. Dr Dennis Burkitt, after whom the tumour was named, was an Irish missionary doctor who worked in East Africa.
Philibert, who had been trained as a nursing assistant, opened our first village clinic in Antsarika, a remote village some 70km from Mandritsara.
vIn September, the Good News School (Ecole Bonne Nouvelle) added a second class (first year of primary) to the pre-school class.

1999 Highlights

In January the inpatient ward was opened with 22 beds. The rental of the former clinic building near the airstrip, 2km away, which had effectively been the ward since operations started in June 1996, was terminated.
Dr Pierre Andrzejewski and his wife Marilena moved to Mandritsara in April. They came from Lille in France and were sent by TEAR Fund UK. Pierre’s task was to set up Community Health work. Marilena’s primary school training was immediately called upon to help give further training to the teachers at the Good News school. Over the next 3 years, Marilena’s contribution to establishing the curriculum and many aspects of the school’s life was to prove vital.

2001 Highlights

By late November we had had 2 months without water at the hospital. The locals told us this was the worst year in living memory for drought. People were digging in the riverbed looking for water. We were still getting a barrel a day out of our well – but that is not enough. Bachy, the drilling company, arrived and set up camp in the last week of November. They suggested drilling in the low-lying land behind the hospital – but we were not happy about that as a long term source as it is not far from the main hospital waste drainage pipes and we were anxious about the long term effects of drinking water possibly contaminated with not only bacteria, but also chemical waste. We suggested instead a spare piece of land just next to our house, close to the water tower and electricity supply. This would make it easy to pump the water into the hospital system. They agreed (afterwards they said it was just to please us – they were sure they would not find water there!) and began to drill. They hit water after 6 metres and then very solid granite. However the granite had fissures in it through which water could pass. They continued to 16 metres and then did a trial pump. 1 cubic metre an hour was the amount they could pump without running dry. We use up to about 10 cubic metres a day in the hospital and houses, so this is enough to supply all our needs for some time to come! How delighted we were at the sight of this lovely clear water! The estimate Bachy had given was for a hole of 30 metres, so we were well within budget and they suggested doing a second hole. We agreed on a site but after 6 metres they were in dense granite with no fissures so gave up. They could not see any other likely site so we are content with what we have! We really feel that the provision of this site was from the Lord. We are borrowing Bachy’s pump while waiting for ours to arrive from overseas. Meanwhile the rains have started and we have town water back on line.

2003 Highlights

In January doctors Paul and Joan Steinkuller arrived. Paul, an ophthalmologist started training Dr Hanitra in eye surgery.

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