Clinic Day 3 - Madagascar MMT Thursday, March 16, 2017

The rains of last night resulted in a beautiful sunrise. Our morning began per usual with French pastries, eggs, and devotions. A wonderful way to begin! We left a bit earlier today as we traveled about an hour to the southern part of Madagascar to the town of Ambohiponana. The drive brought amazing views as we headed into a more rural area. We drove through some flat plains and then into hilly, mountainous country. There were many corn fields and rice paddies in various stages of growth. Our route took a main road until near to the town when we turned off onto a country road. The Malagasy Lutheran Church, our destination, could be seen up on the hillside. The dirt road provided a bit of a challenge for Pastor Tantely, our driver. At one point we all piled out as he navigated a muddy bridge. The last part of the trek involved us walking up the hill with the clinic supplies. We were four wheeling our suitcases up the incline and several Malagasy men from the church came to assist. They slung the bags on their backs and sprinted up the hill. I feel like luggage might need a different design for the Malagasy.

Our clinic day began once again with singing and prayer with the church workers and patients waiting. The people sang a Lutheran hymn from memory, which just has me in awe. All of the team members resumed similar roles today in the clinic as we do not want to disrupt our rhythm and flow. Lisa began the clinic with her daily health education topics with the children, and patients began to work through the various stations of the clinic.

Overall, today we were able to treat 455 patients in both body and spirit. This region of the country brought many patients with goiters, which develop from a lack of iodine in the diet. This area must have an iodine deficiency. We saw many patients with early stage goiters that can be treated with medication that provides iodine. The larger and more developed goiters require surgical removal. One woman shared that she has had her goiter for 20 years. At this point there are complications from the goiter not being removed that include a potential tumor growth in the goiter and heart complications related to her body working harder. Many children were seen with hernias, and several were referred to the hospital for surgery. High blood pressure was another common diagnosis today. We are also seeing worm infections that develop when worms enter the person's skin while they are in water. With rice farming being so popular, this worm infection seems to be quite common. Fungal infections and skin rashes are also prevalent.

LaDonna and Mialy

Dr. Harison treating a patient

Kimberly and Eleanor in triage

The pharmacy crew

One observation from today is the joy the Malagasy people have in their eyes. Despite the hard work and challenging lifestyles they are faced with daily, they remain happy and content. I met an elderly couple in their 80s who have been married for 60 years (they were not certain how many years for sure). They have 14 children together and still farm the land to make their living. The smiles on their faces and the joy in their eyes is magnificent. Just picture the sound of their laughs.

Throughout the day we all took breaks to go outside and enjoy the spectacular views from the hillside. The vibrant colors and expansive horizon were magnificent. The rains moved in this afternoon and caused a downpour for 45-60 minutes. The people all piled into the church and waited it out. This created new mud for us to traverse on the way back down the hillside at the end of the day. I can only imagine how the locals safely complete that trek on a daily basis in the rainy season. It could be like a slide of mud at times.

This evening we were able to experience a bit of the Malagasy culture. One of the nurses who works at the Lutheran Hospital and who served with us early in the week had his mother pass away this morning. Tonight was the wake, and we joined many of the hospital staff to go provide our condolences to the nurse and his family. We walked in the mud to visit the family at their home, which is a very small two-bedroom house where at least 6 family members live. All of the furniture is moved out of the home. The body of the deceased is prepared by the family and placed in one room. Large groups of family and friends come to see the family. A member of the visiting group offers a speech to the family to share the condolences. A family member spokesperson then offers a receptive speech of gratitude. Those in attendance then provide the family with envelopes of money that are gifts to help the family pay for the funeral. Another prayer and speech is given and then the visitors provide condolences to each family member in the room through a receiving line. It was very interesting to observe this custom and how the body is prepared. There are no mortuaries or funereal homes so the family completes all of the body preparation. This wake continues for two days, and then the funeral will be held at the Lutheran church in Antsirabe. Depending on family tradition, the body will either be placed in a family tomb or buried in the ground.

As we learned more about this custom, we discovered that tribes of Malagasy in southern Madagascar have slightly different traditions. For instance, when a man dies his family has to get rid of all of his livestock. This means that if a man has 100 zebu, then the family needs to kill all of the 100 zebu before the body can be buried. It may take 2-3 months for this process to occur and for all the meat to be consumed. The family feels it is an honor to feed all of the people offering their support. Once all of the zebu are gone, the body is placed in the family tomb along with all 100 zebu horns. We questioned why the zebu would not be passed on to the next family member, such as a son or daughter. The thought is that each person needs to earn their own living, but the honor of feeding all of those supporting the family is very important.

In discussing cultural traditions, we also learned that Malagasy people have a tradition of dowries for marriages. In some parts of Madagascar, money is the dowry, and in other places livestock serves as the cost. When a woman is married, she leaves her family and joins the husband's family. In the southern part of Madagascar, part of the dowry process is to steal a certain amount of zebu to provide to the bride's family. It seems that over time families are continually stealing livestock for this practice.

This evening the rains have ceased. Our medications are prepared for tomorrow. And we are all hoping for a restful night as we are weary and needing rest so we can be diligent in the care we provide.

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