This story is slightly unusual, in that I was moved to write it by an urgent call for help that has come from the team in Mandritsara - the need for medical doctors. Staffing levels from August onwards look absolutely critical, and hearing how short-staffed the medical team will be couldn’t help but cast my mind back to the depths of 2020 when I experienced something of what it’s like to try and keep the hospital functioning when you’re desperately short of doctors. My hope is that the Lord might stimulate prayer for this, and also that perhaps there might be a doctor reading this whom God would call to join the team and serve Him there.

“Sorry how long are you going away for?” I mumbled.

It was September 2020, the middle of the Covid pandemic. The borders had closed in April and so since then the medical team in Mandritsara had really just been me, Dr Hanitra, and Dr Rija. And it’s fair to say that after 4 months of 1-in-3 oncalls I was pretty tired.

1-in-3 oncalls means you work all day Monday say, you work Monday evening, and then you go to bed Monday night, but you are still oncall and are called 3 or 4 times overnight, each time jolted awake by your phone (and how you learn to dread that chirpy ringtone after a while!), groping around to find your shoes and your shirt and trekking back into the hospital to try and force your protesting brain to remember how to speak in Malagasy, or at least in French, and maybe even do a bit of medicine and come up with some sort of sensible diagnosis. You then stumble home in the dark, semi-conscious even as you’re unlocking the door, to try and get some sleep before it rings again. Tuesday morning arrives and you do a full morning’s work of ward round and outpatients and then finally get Tuesday afternoon off to catch up on sleep. Wednesday you have a normal working day (still pretty busy!), and then on Thursday it starts again and you have another 24 hours oncall.

…. and now Dr Hanitra wanted to take some leave. Leave she was absolutely entitled to, leave more than that which she needed and which you’d have to have a heart of stone to deny her: now in her late 50s Dr Hanitra had been working in the hospital for over 20 years. Her primary job was as our resident ophthalmologist doing the cataract operations but she was a general medic by background too and so whenever it was needed she would lend a hand to the medicine oncall rota. And now after 4 months of 1-in-3s, she needed a break, she needed a fortnight to rest and wanted to see her family, and who could blame her?!

Which left me and Rija, and probably the single most exhausting fortnight of my 4 years in Madagascar.

1-in-2.

ONE IN TWO.

Could I even do it? Could we function like this? Previous generations of doctors did this routinely in their house officer days in the 80s and 90s but under the comfortable protections of modern employment law, those kind of rotas were banished from the NHS decades ago. Where would we find the strength? Throughout the exhausting months before this, I’d always thought of this as the impossible threshold: 1-in-4, is OK, busy but doable. 1-in-3, hard hard work, but if everyone’s well and working at high capacity, just about sustainable. But 1-in-2…...

And so it began. Work all of Monday daytime and Monday evening. Up overnight 3 times oncall, work a full clinic Tuesday morning. Rest Tuesday afternoon, feel vaguely human for about 3 hours on Tuesday night, start again on Wednesday: oncall again. Rinse and Repeat. Every day either oncall with 3 or 4 bursts of 60-90 minutes sleep overnight if you’re lucky, or recovering from the day before and knowing you had to do it again tomorrow. Life and death decisions. Sick kids and babies. 40+ outpatients waiting to be seen each morning, all of whom are in pain or afraid and looking to you to help them. And of course this is a Mission Hospital! We need to be not just helping them/treating them adequately (which I feel barely capable of by my 4th time round this cycle) but loving them radically and sharing the gospel with them at every chance we get.

What happened? How did it go? How did we get through it? My recollections of that time are blurry at best, but I think I remember the feelings if not many of the details…..

I remember feeling like you’re walking through fog, somehow cracking on and coming up with plans and diagnoses, almost on autopilot.

I remember outpatients being a real struggle, feeling my Malagasy deteriorate as I got more tired and struggling to connect with people on that human level that turns a consultation into a real human interaction and gives you a little opportunity to connect with them and connect the gospel to their lives. Losing almost all of that and being left robotically asking them yes/no questions about their abdominal pain.

I remember on the other hand that on the ward some doors really opened up: patients and their families could see your dedication, noticed that you were there night after night looking after them or their children, still caring, still checking up on them, and maybe it was my imagination but it felt like maybe they did listen a bit more carefully when I managed to explain a bit of the gospel to them during that fortnight.

I remember the care and love of the nurses on the ward and the translators/lab staff in outpatients, looking after me, praying for me, forgiving my mistakes and tiredness and my struggle to find the words.

I remember the support of the team, that tight knit bunch of us out in Mandritsara during Covid and that incredibly precious sense of being so united in our work for the Lord during that time, whatever the costs.

And most of all I remember relying on God in a way I’ve never known: I’m such a proud and self-sufficient person that most of the time I really just rely on my training, my skills, my gifts, and only pray as an afterthought or to simply pay lip service to depending on God. And yet here I was, so exhausted and faced with a situation that even I, in all my pride, didn’t think I could manage in my own strength, driven to pray like I’ve maybe never prayed before. And seeing those prayers answered: that we got through it. That we worked that unsustainable fortnight and instead of coming out of it broken and at the point of emotional breakdown, I came out of it trusting God more. I came out feeling like I’d lived a little more some of my favourite verses at the end of Isaiah 40. Knowing very deeply that:

Even youths shall faint and be weary, and young men shall fall exhausted; but they who wait for the Lord shall renew their strength; they shall mount up with wings like eagles; they shall run and not be weary they shall walk and not grow faint.

He sustained me and kept me going. He probably worked in me and through me more in my weakness and exhaustion than I ever let Him when things were going well, and to Jesus alone belongs the glory for everything we managed to do during that crazy season.

1. Please pray for the urgent recruitment of new medical Doctors to the Good News Hospital. These memories are from 2020, but with 4 of the 6 medical doctors currently working at HVMM planning to leave Mandritsara in the next 6 months, the medical team are currently facing a 1 in 3 rota from the start of August, and a 1-in-2 rota from the start of October. God has amazed us in the past by sending help just at the right time. Would you pray with us that He would call medical doctors to join the team soon so that the work might continue unhindered? This is very urgent.

2. Please thank God for his sustaining hand- so many of the different teams (medical, surgical, nursing, midwives, lab staff etc) have faced moments over the last few years where they’ve been extremely short staffed and really feel the work weighing heavy: thank God for the way He’s always carried us through those moments and please pray that when those times come round next they would bring the team closer to Him and make us all more dependent on Him in prayer.

3. Please pray that even in the busy-ness, the hospital’s unique work of holding out the saving message of Jesus’s death for sinners, and loving our patients with the compassion He’s shown us would continue. It’s so easy to get sucked into thinking it’s too busy at the moment, or to get caught up in all the medical needs- please pray that everyone from the heads of department down to the newest health care assistants, Missionary or Malagasy would keep listening to the Spirit’s prompting to take the opportunities He brings our way to share the gospel now, in the day of salvation, as long as it’s called today.

The Good News Hospital has an urgent need for medical doctors from June 2024. We are looking for long term doctors (GP / internal medicine / A+E trained). We are also looking for short term medical doctors (6-12 months) who have at least 2 years of professional experience post-qualification, and who can speak some French. If you or someone you know might be interested, please ask them to contact the missionary team leader by email at ted.watts@mandritsara.org.uk