by Douglas Robertson -
retired GP from Glasgow, and chairman of Friends of Mandritsara Trust UK
After a five year gap, my wife Margo and I returned to Mandritsara with a view to helping supply clinical cover for the missionary team during a long-awaited and well-earned Team Retreat. Before offering my services, I checked with Ted Watts, our Team Leader, and Tamsin Booth, a London based GP who has recently visited Mandritsara and is still working, to ask if my services could be of any value.
Both clinicians agreed that I should come and were confident that I could make a useful contribution. The months before coming out saw me re-reading the Oxford Textbook on Tropical Diseases which I recommend to all clinical volunteers, and making some effort to brush up my French. Both exercises were enjoyable but challenging!
So, what have I discovered since I was last working here in 2019?
A number of changes have taken place in these past few years:
1. There has been a huge expansion in the Good News Hospital facilities. The new Surgical Block is fabulous - bright, fresh, clean and looks very up-to-date in every way. A new dental department is just getting underway.
Margo Robertson with dentist Debbie Hardyman in the new dental surgery
2. There is now a larger team of surgeons and physicians, mostly from Madagascar, which is good and very promising for the future. This is partly due to the hospital becoming a training centre for Christian surgeons under the PAACS Surgical Training Programme.
Medical staff prayer meeting at the start of each day
3. The out-patient clinics are much busier. I have seen many more patients each day than I did on previous visits.
The newly expanded Maternity Unit is very nearly complete. I have taken an interest in the building works as they have progressed, with the final details of a walkway from the new Maternity Block to the new Surgical Block. I am just a nosey amateur builder but I like to watch builders anywhere when they are at work!
Maternity Unit extension - exterior
Maternity Unit extension - interior
Many things, however, have not changed:
1. The regular morning evangelistic service in Outpatients. Large numbers of people attend these short services each morning before they are allocated to a clinic. Proclaiming the Good News of salvation through Jesus Christ is the very heart-beat of the project.
2. The Community Health Care Team is still very active. They are delighted with their new Land Cruiser to facilitate their work. Each rural visit has several aspects – a short Bible-based evangelistic talk, some health education, a vaccination programme for children and pregnant women and in certain centres an eye clinic and eye surgery.
3. Mme Noro (pronounced Nooroo), my translator, and I were reunited when I arrived. I think that she is the manager of the outpatient clinics.
4. The Tuesday Oasis Guest-house Missionary Team lunches continue under Claudia’s skilled guidance.
5. The almost universal poverty remains a daily challenge for the clinical staff. Many patients simply cannot afford a Chest Xray (about £3) or an Ultrasound (about £1.30).
6. The limited range of affordable drugs available.
7. The general warmth, kindness and enthusiasm of the staff is always refreshing.
8. The occasional interruption to a clinical consultation by a mobile phone or a colleague is a novel experience for a Western Doctor but seems to be acceptable here (I had forgotten about this cultural nuance). With my limited French the consultations have been more challenging than I had anticipated. However, Mme Noro knows me very well and seems to be able to read my mind very quickly!
As one gets older, certain aspects of clinical care become more distressing and challenging. The extreme poverty of so many patients is hard. Many people simply cannot afford a basic range of investigations or treatments that we can offer. Sometimes my suggestion of a Chest Xray, or an ultra-sound scan, is politely declined. There is a hospital Poor Fund, but this is used mainly to subsidise expensive urgent or essential life-saving surgery or treatment.
The hospital Management Committee are planning further developments to the hospital, with improved Laboratory and Xray facilities. The hospital has also recently received new ultrasound equipment and gastroscopes. The new equipment will enhance the degree and quality of care that can be offered. However new facilities will put pressure on the hospital fees.
One young couple that I saw last week had walked for five days to come for treatment. Following the medical history and investigations I suggested they remain in Mandritsara for the weekend so that I could check the patient again a few days later. Sadly they said they did not have enough money or food to stay that long, they must go home again.
In order to meet this daily challenge, the hospital would like to extend the Poor Fund to subsidise investigation and treatment options available to the very poor. I think that this is a great idea and could enable us to better help a greater number of patients.
There is no doubt that UK clinicians struggle with this aspect of clinical care. We live and work in a unique setting in the UK where all health care is available free at the point of need. No other country has approached anything like this universal service. Such a service cannot be transferred to Madagascar. So we must consider new and alternative methods to address the needs of so many people.
We are thankful to the Lord to be here. Each day it seems to be getting hotter, but Margo and I feel very much at home in the project and in the local church. I have been busy leading Bible Studies, speaking at different gatherings and will be preaching tomorrow morning in the church. I have even been a blood donor!
For Prayer:
• Will you pray for this pressing need for the very poor? I hope that you will.
• We anticipate the visit of several Government Officials for the formal opening of the new Maternity Unit on October 18th. Pray that these men and women will be struck by the ethos of the Good News Hospital and Project, and as the leaders of the project point to God as the source of all, pray that the official visitors will come to sense the goodness and love of God.
• During a recent visit by Ted Watts (Missionary Team leader), Mme Rindra (Project Director), and Marc Ratovo (Hospital Spiritual Counsellor) to the Regional Medical Authority, the senior administrator expressed his sincere delight regarding the nature of the work at the Good News Hospital. Pray that the work of God through the hospital will spread to the whole region and beyond.
• Please commit the hospital leaders and workers to the Lord, that they may have wisdom and skill, compassion and kindness, and a spiritual burden to share the Good News of Jesus through all they do and say.
Date for your Diary!
Virtual Prayer Day - 30th November 13:00-15:00