Step by Step....

Maventibao

The Clinic

Some of the children in the village.  So eager and so curious!

My hut!  It has been such a wonderful home.

Just as I think I am getting into the routine of life here in the village, I find myself in a situation where all I can do is call out to God for his guidance and grace.  The two volunteer doctors left 4 weeks ago.  Because I have been shadowing them in the past 4 weeks and have just been recording down the diagnosis and treatment of the patients, I began to wonder if I would have much of a role in the clinic when they left.  I thought that maybe I would work in the clinic again when the next volunteer doctor comes, since it would just be extra work for Nono to translate everything.  I just assumed that the full-time nurse at the clinic would take over until then.  Silly me.   Little did I know that when the doctors left I would be considered the closest one to a “doctor”.  My role went from just being an observer and a recorder to being considered as an actual “doctor”.  Because I am not even close to being as qualified as an actual doctor, I really was not at all expecting this and was in every way shocked.  Kristen, a biology grad, arrived a couple weeks after the two doctors left.  This softened the burden slightly as it has been great to have another person helping out in the clinic.  But she too, found herself in a similar position.

I began struggle with how unethical this is.  It is one thing when you are under the guidance of a doctor, and another when you are making the decisions as a doctor. I have been under the supervision of the nurse here at the clinic.  So I have not been completely on my own and I have definitely not been signing any of the patient history books (you have to be certified to do that).  Anyone in Madagascar can get access to medicine and there is no gateway system like there is in the U.S.  Basically if someone wanted to take codeine or Amoxicillin, they easily purchase it over the counter.

I prayed and prayed and soon realized that I do have some knowledge from my classes and reading that I have done, and especially by shadowing the doctors the past month.  Being aware of the symptoms of malaria and of some other very common parasitic diseases like shistosomiasis, which according to my readings 80% of the population is at risk and 1/3 is infected, I learned has been beneficial to know.  I can offer some insight,  but that is it.  I refuse to take on the name "doctor".  The quality of healthcare one receives should not be defined by one's economic status.  My dream, as it has been for years, is to become a missionary doctor.  Until then, I am simply an untrained intern.

Interning in the clinic can sure be difficult at times and I have learned to take things step-by-step.  It is difficult working in a rural setting; there is only so much one can do.  Death is much more of a reality here, especially for babies.  Since I have been here, there have been two babies that have passed away.  The other day a four month old baby came in with fever.  The clinic does not have anything for a baby that young. And because I am not a doctor and have no medical knowledge on babies, all I can do is observe the situation.  The clinic was low on medicine as is and only had 400mg Ibuprofen coated pills.  There was nothing that the clinic could do except recommend a sponge bath or to take the baby to the hospital.  But going to the hospital is rarely an option.  Mada Clinics is trying to get the 4-by-4 fixed so we can take patients to the hospital if there is a medical emergency.  I learned first hand just how important the 4-by-4 is when I got word that the baby passed away the following morning.  It was absolutely devastating to hear and I have been thinking about that precious baby every single day.  

I have also realized that when in a rural area, you cannot expect to have certain things.  Necessities that you would expect in any health care setting, like having proper testing, are forced to be luxuries that the clinic does not have the adequate funding to expend. The clinic has come such a long ways though, and I can go on and on about how much it has blessed the villagers.  For instance, everyone in Maventibao has at least 1-2 mosquito nets and everyone is provided with toothbrushes and toothpaste.  Mada Clinics offers free primary school school education to the kids in the surrounding villages.  Mada Clinics is working towards providing the kids with secondary education, but that of course is not an easy endeavor.  It cost the equivalence of $150 per month for a child to go to Diego Suarez for secondary school.  I pray that this beautiful opportunity that come to formation.

Even though the things you see are not easy, I am so thankful to have the opportunity to work with this organization.  Mada Clinics is a registered Madagascar NGO and is the only known non-profit organization that offers free healthcare. This is huge being that the majority of the people make less than $2 a day.  People have traveled 200 kilometers just to get free healthcare because it would be far cheaper to travel the distance than go to their local doctor. The nearest hospital is 2 hours away by taxi brousse.  And if you live in Maventibao, you have to hike 9 kilometers to the nearest village that the taxi brousse stops at.  People come to the clinic because it is their only option. 

On Wednesday and Friday we have walking clinics.  These are very tiring, especially the Friday clinic.  We have breakfast at 6:30 and then head out on a 10-kilometer hike to a village called Matsara.  In Matsara, there are about 45 patients in a day.  We typically get back to Maventibao around 8 pm after hiking 10 kilometers back up the mountain.  

Although it is tiring, it is more so emotionally draining because it is simply heartbreaking in what you see.  For instance, a mother brought her son and daughter in.  Her daughter was gaunt and emaciated.  To put it in perspective, she was 7 years old and was the same size as her 4-year-old brother, who was also very thin and looked like he had kwashiorkor.  On top of that she had diarrhea and vomiting for 5 days.  Not only was she malnourished, she was extremely dehydrated.  We gave her oral rehydration therapy immediately and gave both of them multivitamins.  We encouraged the little boy to eat a lot of beans, the only protein-rich food available.

Multivitamins and iron/folic acid supplements are something I feel comfortable handing out.  They are not potentially harmful, like antibiotics can be, but are immensely beneficial. I have read that 7 out of 10 women in the Antsiranana province are anemic.  And 40% of the population is under the age of 15, that means that there is a large percentage of women that pregnant and/or breastfeeding. Multivitamins and iron/folic acid supplements can make a huge difference during pregnancy, especially in the 3rd trimester and the following few months after birth.  And I have to say thank goodness there is the British National Formulary that one of the volunteers left behind. It has been a great reference tool.

I have realized that it is especially difficult to know what to do when a pregnant mother has symptoms of a S.T.I.  All I can do in those situations is strongly encourage the new mother to visit a doctor and get tested so that she can get the proper treatment. But I know that is not always an option because it is expensive.

Most cases seen in the clinic are not severe and are mostly acute respiratory infections, S.T.I.s, U.T.I.s or toothaches.  In addition to needing a doctor or nurse, a dentist is just as needed.  I have learned a toothache is never simply a cavity.  A 25-year-old woman came into the clinic with a toothache. The center of her tooth had eroded to the gums.  There was literally a hole in her tooth.  There have been children that have come in with toothaches and their teeth have already begun to erode.  It is very sad to see. Dental hygiene is almost non-existent in Madagascar, at least in the rural villages.  Visiting a dentist is not an easy endeavor and there is, at least from what I can tell, little education on dental hygiene.  But it is extremely important because not extracting the tooth and cleaning the gum can lead to a dental abscess, which in worse case scenario can spread to the brain and cause encephalitis.  Recently I went to the main supermarket in Diego because i needed dental floss, only to realize that it was $10.  This was disappointing, mostly because I knew that obviously the majority the population does not have access to simple things like dental floss....something that I easily take for granted in the U.S.

I have been to the two different hospitals in Diego in past couple days.  Those visits alone were quite interesting.  I went to the main hospital in Diego because there was because there was a man who came to the clinic with massive swelling in his arm and a woman who had a severe ear infection and was blacking out.  They both seemed serious and since Nono and I were going to town that day I told them they could come with us and go to the hospital.  Last night a group of us went to the Military Hospital because one of the volunteers was ill.  They gave her systematic relief but did not give a diagnosis, which was interesting.  She is feeling better now, thank goodness! 

Although it has been overwhelming, there have been many exciting things that have happened in the village this past month, like the huge Independence Day celebration.  I also still feel as though I am walking in a postcard when I hike to the stream for water or to do my laundry.  The scenery never gets old. I will end with a story of an amazing event that happened in the village. It simply show how prayer is so powerful.

It involves a young woman in Maventibao.  She is only 16 and in her 3^rd trimester of pregnancy.  The young woman had a stillborn last year and was told by the doctor in the city that she needs to have a cesarean section for her next pregnancy.  Kristen, the other volunteer, and I really encouraged her to make arrangements with her family that live in city with the closest hospital.  Not only were the mama and the baby at high risk, Kristen and I are not doctors and we were the only volunteers in the village at this time.  Within the next few days she returned to clinic with a fever and bronchitis.  We continued to stress the urgency of going to the hospital, but when we got word that night that her water broke, it simply became no longer an option.  

So we spent hours into the night in her hut watching, waiting and praying.  It was really neat to see all the women come together and help her while she was in labor.  Ranopango (rice water) was passed around and the women worked together while she was in labor.  When her contractions were close enough for her to push, she began to push and push…. but the baby was not crowning.  The midwife and the women in the hut became concerned when the baby was not crowning after hours of pushing.  It was then, that the mother had no other option than to embark on the 9-kilometer hike down the mountain to catch a 2-hour taxi brousse ride to the nearest hospital.  I was so concerned for both the mama and the baby's health, because if the baby is not able descend through the birth canal, then both the mama and the baby are at a high risk of death.  Because the taxi brousses fill with as many people as they can and you can never fully depend on when they will arrive, Kristen and I agreed to pay for cost of hiring a 4 by 4 in Ambrondimafhey to drive her to the hospital.  As I was running to catch up and give the mother and giver her the money I was told that the baby crowned and the mother was giving birth. 

Thankfully, she walked only about 20 feet and the baby crowned and she gave birth to a gorgeous baby girl.  I was so relieved when the newborn began to cry that I started crying with tears of joy.  Praise God for a healthy baby and a healthy mama. The village, relieved as well, celebrated by killing a chicken.

Although I have a lot more to say, it is time to cap it off (definitely the longest blog yet!).  I have realized that it is in these ups and downs, heartbreaks and miracles, that I have sincerely felt God’s presence.  Also, hitting my head on my pillow at the end of the day has never felt so comforting.   I am taking the next week off so that I can catch up on my schoolwork.  I may or may not go to the beach for a nap...just taking things one step at a time. I am so thankful for everyone that has been supportive and has been praying for me!  It means so much. And thank you so much for reading my blog! :)