Sunday, April 17, 2022

What isn't going on?

It’s amazing how busy life can get even when you are in the middle of remote Madagascar. Life is just busy whether it be homeschooling, work or just life. 

The launch of the new Pan-African Academy of Christian Surgeons (PAACS) surgical training program has been a major success! 

I am so unbelievably excited to see surgical care improving by leaps and bounds. There is nothing like seeing our trainees become independent in doing C-sections or become more proficient treating critically ill patients. Praise God! Our two trainees are busy studying for their first set of  exams in June (which must be done in english). Both have had to learn english to be in this program. So, we communicate amongst ourselves in english, but we need to speak to our nurses in french as most of them don’t know english and then to patients in 1 of 2 dialects of Malagasy (as they generally don’t know french or english). It can be a word salad some days. I should also mention that when “we” speak in english it may be a Canadian, British, Irish or Australian accent. I should also add American because my Malagasy surgical colleague was trained by Americans and he has adopted some of their accent! We are definitely a salad of international staff!

I am overwhelmed and humbled by the FAIR "Out of the Waiting Room" appeal to raise money for our surgical education program here in Madagascar. 

Our original goal was $145,000 CAD. To date, over $230,000 CAD has been raised! Thank you, thank you and Praise God!

Our new ICU and recovery unit headed by a critical care nurse from Ireland has saved at least 3 patients’ lives and I suspect many others since opening in March 2022. Prior to this, patients had really no option but to go to the surgery ward which was not equipped to deal with sick patients. We now have a dedicated team of Malagasy ICU nurses. Another major step forward. The Malagasy writing on the wall is Psalm 121.


We recently had Engineering Ministries International (EMI) remotely assess our hospital infrastructure for water and electricity as we felt we were outgrowing it. Our suspicion was correct and their report indicated much of our electrical and water infrastructure needs upgrading. We will be hosting 3 EMI engineers from South Africa later this month as they come to provide detailed plans for some major upgrades in these areas. Our hope is that this will greatly address current needs but also provide for future expansion. 

With detailed engineered drawings, we can better cost out the upgrades and begin working on what needs to be done and we have the financial means to do. If I think I only want to operate as my job and not work to improve infrastructure, I find myself thinking again because performing surgery can’t happen when electricity is poor or there isn’t enough of it. The same goes for water.


But all these big picture projects are really intended to make a real difference in people's lives. This week I saw a smiling 18yo mother in follow-up in my clinic. She has a young child. Someone tried to kill her with a machete several months ago and she arrived in a terrible state while I was on call. She sustained unimaginable injuries including two large open skull fractures. I honestly didn't think she would make it. I spent 4 hours trying to reconstruct one of her hands with 9 tendon repairs, a wrist fracture and a nerve repair while my resident worked on some of her other injuries. In clinic, she can move her fingers and hand more and more each day. She has no pain. She now comes to my office with a huge smile. She tells me how her young child is doing and I remind her how sorry I am for having to cut her long braided hair to fix her. She laughs and says "tsy maninona" which means no problem. She is neurologically normal. Praise God!

It seems like a lot on the plate some days…and it is, but this is what it looks like to improve healthcare in a developing country. It means building systems that will last, training surgeons, nurses and departments, modelling compassion and trust, pooling and stewarding resources, and helping empower a community to care for its own. When the days are busy I often find myself looking to the hills and reminding myself where my hope comes from. JESH