9th to 13th October, 2023
Ankavandra is one of the very remote communes in the Miandrivazo District. The road is almost impassable; 2 trucks connect Ankavandra and Tsiroanomandidy instead of bush taxi, a 140 km road but a journey of 2 to 3 days by car. Ankavandra has approximately 10,000 villagers, most of whom are farmers and fishermen, and is among the red zones in terms of security.
Our team consisted of 14 people including 12 clinicians and 2 pastors. Like each mission in Ankavandra, the logistics were complex, with five travelling 1.5 days by car to Tsiroanomandidy and then by plane. The rest flew direct from Tana. When we arrived at the Ankavandra airstrip many of the villagers were already waiting for us to transport the materials; the mayor with his colleagues also welcomed us at the airstrip.
The journey from the airfield to the village is hard in the heat, including a 1 hour walk and crossing the Manambolo river. During the dry season, the level of the river is very low and you can cross it on foot.
After setting up the tents and equipment, we made the courtesy visit to the village. Every year, we use the dispensary of the FJKM Ankavandra church to carry out our activities with very strong collaboration from the midwife/nurse who is primarily responsible for this dispensary. She is the one who ensures the post-operative follow-up of MMS patients. The building is not in a good state, especially the ceiling and we had to use tarpaulins to cover it.
At 8am on Tuesday we began the day with a religious service led by the Pastors of the Ankavandra churches and our team pastors, followed by a speech from the mayor for the official opening of the mission. Afterwards, presentation of the whole team, and information concerning the progress of our activities to all the patients who came in large numbers.
Many of the patients live very far from Ankavandra, some are even near Ankondromavo, Bekopaka, Soaloka. One woman had walked 100km over 3 days with her two children (7 and 8 yrs old).
Most patients still practice witchcraft, which is a bit difficult, especially for the surgical team. One young girl was operated on for a myoma under local anaesthesia. She spoke to the anaesthetists during the operation and thanked the whole team. But when she left for the post-operative room, she became strange, made a big look and became unconscious.
The anaesthetists checked all her parameters and everything was normal, her condition stable but she just stared into space. 2 hours later, we heard a religious service in the post op room, we went to see what happened. According to her family, the girl had a crisis (nothing to do with her health), in Malagasy we call this “tromba”, in fact, she was possessed by a spirit, that’s the “ tromba”. And it is this spirit which reacted in her because the fact that she shed blood did not please the spirit.
According to the explanation coming from her sister, she had been possessed for a very long time. Since we left, the young woman remains unconscious, yet she reacts when someone pinches her or places something on her face like mooches or mosquitoes. We encouraged her family to pray with her every moment because it is the only solution to get this demon out. Church leaders, and our team pastors also came to pray with her family.
MMS is not only a medical mission but above all a spiritual mission. Our team pastors worked a lot during this mission, they spent the whole week evangelizing in the village, visiting homes for spiritual encouragement. They showed a Christian film on Thursday evening before our departure; everyone came in large numbers.
On the Wednesday we had a visit from our CEO John Greaves, and a group from MAF Norway, along with pilot Patrick, Michael (new MAF Madagascar director) and Andry (MAF Logistics). It was an honour for us to receive them and show them how things really work with the MMS. We showed them around our base, and despite the heat, they were very motivated to visit the village. The gendarmerie and the head of the commune took a great initiative for the safety of the plane during this visit and their safety on the way to the village.
Given the large number of patients that we had not yet been able to receive, we decided to continue working all day on the last day of the mission.
Dadamene, a 15-year-old boy, was brought to the MMS on Wednesday by his aunt who is taking care of him. He has had a heart disease problem for a year, his heartbeat is very visible on the outside and his rib cage is starting to deform. He needs to get to Tana for a cardiology examination. The MAF group visiting agreed to help him and we offered to take him to Tana on the Friday, to travel back on the plane. We told his aunt to come and meet us at the airstrip on Friday morning but unfortunately, they didn’t come. From what we were told, they had changed their minds because they are afraid of going to Antananarivo, and of being lost there. Very sad, especially as our established Medevac process covers looking after patient and family as needed.
Most of the cases consulted for general practitioners are tuberculosis. People say that drugs for tuberculosis are expensive and they cannot afford to buy them. Other conditions include sexual diseases, sterility, mycosis, hypertension, cough, gastritis. For surgery, hernia, hydrocele, hysterectomy, lipoma, bullet wound. For ophthalmology: myopia, cataracts.
Below left: facilities are basic; Centre: We have constructed a well at the base, and Right: a new latrine we built to replace the old, unusable one
Medical consultation 219; Ultrasound 97; Dental extraction 96; Surgery: major 20, minor 9; Ophthalmology 45. Total: 486