Tamsin is a trustee of Friends of Mandritsara Trust, and a GP in London. She has spent four previous spells in Mandritsara – this time she was there just for a short visit. Here is her report:
“I will give them a heart to know Me, that I am the LORD. They will be My people, and I will be their God, for they will return to Me with all their heart.” Jeremiah 32:8
Although it has been 6 years since I was last here, I still feel at home as I exit the fancy new Chinese built airport into the warm afternoon sunshine. There are some new and different things – like the airport, and the fact that it took me 25 minutes to get from the plane to the exit with my bags (it used to take 2-3 hours)!! But also lots of familiar things – the smiles and warmth of the people, the business and chaos, the colours and the poverty. That makes me sad – that in 6 years there has been no improvement. In fact in some ways the situation seems worse. Many businesses including restaurants and hotels have closed. There are next to no tourists and my taxi driver tells me he has given up hope. There are elections in November, but nobody believes they will be fair. Thankfully there is always hope in the death and resurrection of Jesus, even in the darkest of times.
Early the next morning, I boarded my MAF flight with Patrick and Ryan flying us. MAF are such a wonderful organisation, and so great to be able to pray with the pilots before we fly. What a privilege to fly across God’s beautiful creation – this huge island, scarred by humans, but still awesome – the endless red soil, the hills, the small patchwork areas of rice plantations. As we approach Mandritsara across the hills, I have that same emotional, excited feeling I always have. But this time it is mixed with a sense of worry when I look down and see the river – a river which should be full at the end of the rainy season, but is completely dry. And the rice fields which should be green and ready to harvest are brown……Rice is the staple diet for the Malagasy people, and failure of a rice harvest means hardship and hunger……
But despite this hardship, as we land, we are surrounded by the smiles of the people lining the airstrip to greet us. These smiles fill my heart with so much love! In London, where we have so much, nobody smiles, and yet here, in the midst of so much challenge, everybody smiles! The drive to the hospital was reassuringly similar – there is one random strip of new tarmac, which is very exciting, and there are hundreds of yellow Bajaj buzzing around everywhere – yellow motor taxis built for 3 people, but carrying up to 10 here in Madagascar! There is now even a taxi rank outside the hospital!!
It was so good to see so many familiar faces, and meet so many new people. The team has changed, but so has the hospital – I got lost on the compound a couple of times with all the new houses, and of course, it was so exciting to see the new theatre block and recovery suite in action. I was amazed (and relieved) to find that there is now a separate medical and surgical on call – so the medical doctor on call no longer has to cover the surgical wards and admissions at night. The surgical cover for outpatients during the day is also amazing – with on hand surgical advice and ultrasound available. In fact the surgical team is now pretty well covered which is a miracle, and so exciting to meet Marco and the trainees – Tefi, Rado & Sky, and see so many faithful Christian men being trained to serve as surgeons. Please pray for the medical team who are less well supplied, and have a less experienced and stable team. Pray for some experienced Malagasy doctors to join the team and want to stay, as well as younger doctors who are happy to train as General Practitioners. It was such a joy to meet and work with Dr Mbola and Dr Desirée and see their enthusiasm to work as part of the project. I especially enjoyed the morning prayer time with the team before we started our day – that is a new a great addition to the day!
My time at the hospital seemed to fly past. I was so nervous that I wouldn’t remember anything after 6 years, but God was so good, and both my Malagasy and my medical knowledge returned very quickly – in time for my first on call on Coronation Day! I loved being back in the hospital – still amazed every day at the resilience of the Malagasy people. We saw one man who came in who looked whiter than me – his Haemoglobin (blood count) was 3 (normally 13 in a man). In the UK the person would likely be collapsed, and this would be a medical emergency….but he had walked here from Mananara! He needed lots of blood transfusions, and even then we couldn’t increase his blood count, but could not work out why. In the end, with Alison Brownell’s (Consultant Haematologist in UK) help via WhatsApp, we worked out that he probably had lead poisoning from the fillings in his teeth!! He was able to be discharged under close supervision.
That is another amazing thing – the internet here is so good now that every day we are able to get advice from our amazing colleagues all over the world by sending pictures and messages on WhatsApp. We had another case of a little girl who was admitted really short of breath and blue because she was not getting enough oxygen. Dr Rachel Watts and the medical team here were able to diagnose a likely congenital heart condition with the help of a Consultant Radiologist and Paediatric Cardiologist via WhatsApp from the UK. After lots of care and prayer, she was able to be discharged off oxygen, to go to Tana for further scans and possible surgery.
While I was there, there was a sudden surge in Malaria. At one point we had 4 children with severe malaria on the ward. One little 4 year old came in while I was on call. She was conscious, but very weak and pale. She also had a very low count, and needed a transfusion. Her blood group was A+ - same as mine! So I was able to give her a little bag of my blood. There is no blood bank here, so blood is taken when needed from relatives if possible, but if no relatives match, then the search is widened to staff and local residents who have agreed to be on the list. One real encouragement while I was there is that I saw 2 patients who volunteered that they wanted to give blood if needed. One was a man who came in to outpatients with a minor condition. He was B+, and was able to donate to a much younger man who was really unwell with a terrible stomach bleed.
The local government hospital has also started to run a transfusion service, so please pray for the practicalities of this – we want to work together and support other services, but are not yet sure about the screening processes they use, so please pray for wisdom in managing this relationship. Also pray for the lab – they are so busy with all the new services provided by the surgical unit, and the new tests available. Please pray for wisdom as they consider expanding the service, and for new staff to apply.
One really difficult and sad thing which has happened since I was there is the advent of HIV and AIDS. I had been convinced for a long time that God was protecting Madagascar from this epidemic, and that maybe there was some genetic reason that Malagasy people were not contracting HIV. Unfortunately that is not the case – I am so grateful that the island has been protected for so long, but sadly the virus is now taking hold. The epidemic really started a few years ago when gold was found not far from Mandritsara. This swelled the population and brought money and prostitution. This all spilled over into the twice monthly Sabotsy Be – the huge cattle market which brings people from all over the region to the town. These people contract the virus during their time in Mandritsara & then carry it back to their villages far and wide. I saw several cases of HIV and AIDS while I was there, and it will only get worse. Mandritsara is one of the worst affected areas in Madagascar – it is a “red zone” on the National Public Health map. Please pray that this provides new opportunities to bring Jesus into people’s lives.
I treated one 28 year-old lady who arrived with her husband from Mananara. They were both HIV+ve, and have 3 young children. She has AIDS and is really unwell. We were able to speak with her about Jesus and pray with her. She probably does not have long to live, so I am so grateful they came and she had the opportunity to hear about Jesus, and I pray that she is able to accept him as her saviour soon.
The advent of HIV has also provided other opportunities – the government hospital – Hopitaly Be is providing free HIV testing, and also has free medication. So we have been able to work closely with them with patients who we diagnose or suspect HIV. It is also great to be able to encourage patients that the medication is so good now that if they take it regularly, they can live essentially long and normal lives. The Community Health team has a massive role in all of this – to educate all the young people in Mandritsara and the villages around about HIV – it is such an opportunity to speak about Jesus, and what he teaches us about relationships and marriage. Andry from the Community Health team has a real heart for the youth, as does Berton from the Evangelism team, and they are organising some big youth events over the next few months, so please pray that these events are really well attended, and for wisdom for those who will be speaking.
The other massive challenge is the drought and the failure of the rice crop. There is no water in town, and those who can, are already having to buy water from Jirama (the water company). This normally happens around the end of August, so the fact that it is happening in May is a real worry. The next few months will see the price of rice soar. There will be food insecurity, increased poverty, and malnutrition. There is a real sense of fear about what the next few months will look like, so please do pray for those who know God to really trust in him through this difficult time, and that those who don’t would turn to him in their hour of need. I was reminded of this verse:
“I will give them an undivided heart and put a new spirit in them; I will remove from them their heart of stone and give them a heart of flesh.” Ezekiel 11:19. This is what I pray for the people of Mandritsara.
Before I end, and on a more positive note, it was wonderful to attend the Baptist Church in Ambohimandroso (the village where the hospital is located) on Sunday. Last time I was there, they were a very small church with no proper building. Now they have really grown in number, and they meet in a great church building with a metal roof! There were 9 baptisms a couple of weeks ago, so we can praise God for growing his church in Mandritsara, and the real encouragement that is.
Lastly, Mme Faniry, the Head Teacher at The Good News School had a beautiful baby girl – please pray for her and her family, and for the school while she is on maternity leave.
Leaving is always so hard, especially after such a short time, but I leave with so much encouragement at the resilience and faithfulness of God’s people here in Mandritsara, and it will definitely not be 6 years until I am back again!
Thank you for praying!
Tamsin
Please pray that God would call experienced, long-term, Malagasy medical doctors to join the team.
Pray for the Community Health team as they seek to teach young people in Mandritsara and the surrounding villages about HIV and about Jesus and what He teaches about relationships and marriage.
In the light of the current severe water shortage and the soaring price of rice, pray that those who know God may trust Him at this difficult time.
Pray for Mme Faniry, the principal of the Good News School, and her new baby girl. And pray for the school while she is on maternity leave.