Medicine in Madagascar

After completing ST5 in Acute Medicine, I had the opportunity to undertake an out of programme experience. I volunteered with the charity Mercy Ships in Madagascar. Mercy Ships is a faith-based international development organisation that deploys hospital ships to some of the poorest countries in the world. They deliver vital, free surgical care to people in desperate need, as healthcare is simply not available.  

Madagascar is a beautiful country with welcoming people, stunning coastlines and fascinating wildlife. Did you know there are over 100 different species of lemur? Or that 80% of the flora and fauna in Madagascar is endemic to the island? However, life on the island is hard. Most people live in extreme poverty with limited access to fresh water, poor infrastructure and frequent cyclones that destroys what progress has been made. Therefore, assistance from medical organisations, like Mercy Ships, is very gratefully received.  

My main role as Hospital Physician was to optimise the health of patients to enable surgery to proceed safely. I also had a role in protocol development and providing education for local professionals to ensure that the impact is long-lasting. This involved reviewing adult and paediatric patients, many of whom had never seen a health care professional before, diagnosing and treating both acute and chronic conditions. This ranged from familiar conditions such as asthma, seizures, URTI, UTI, thyroid disease, arrhythmias, malignancies and diabetes; to conditions which are much more common in tropical countries such as malaria, schistosomiasis, HIV, TB, tungiasis, parasitic worms and severe malnutrition. The job also included managing the small ICU, rounding on both pre and post-operative patients with surgical colleagues, and working closely with the wound care and rehabilitation teams.  

This experience exposed me to working in a different culture with very different health beliefs including traditional healing methods, strong spiritual factors, and fear of curses which cause ill health. All of these had a huge impact on the way my patients viewed their own health conditions and therefore became a part of the clinical consultation, allowing me to develop a fresh perspective into patient centred care.  

One of my favourite things about the organisation is their commitment to providing education to, and learning from, local practitioners. There is a real awareness that this is the way to achieve true, long-lasting change. Therefore, local nurses are invited to work on the wards on the ship and a local surgeon participates in every operation. Partnerships are formed with the local hospitals to ensure MDT learning. It was a privilege to be involved in providing education and mentorship for local professionals, including giving feedback and learning of culturally appropriate ways to do this.  

This was my third trip to volunteer with the organisation, having previously spent time in Benin (post FY2) and in Senegal (after completion of ACCS). One of the main things that continues to draw me back, is the opportunity to work with people from all over the world with vastly different experiences. At any one time, there are people from over 40 different countries volunteering on the ship. This rich diversity encourages me to view situations from a new perspective and has allowed me to develop my own communication skills to ensure that the whole team is communicating effectively. Working in an environment where the resources can be limited, forces you to enhance your problem-solving skills and discover that often there is often more than one correct solution to a problem. Working alongside local people assisting as translators on a daily basis also allowed me to develop friendships and become more enveloped in the local community. I was able to visit their homes and families and enjoy meals together. This was a true joy.   

I am grateful that I have been able to use my medical training and experience to help the people of Madagascar in a small way. I am also aware that I have gained so much more from the experience. I am confident that the skills that I have gained and developed will allow me to be a better practitioner and colleague as I return to the NHS to complete my acute medicine training programme and thus I am thankful for the OOPE opportunity.