Blessings from Marofatsy

imageimageimageimageI write from Marofatsy in the district of Marolambo, Madagascar.
James and Corty are analysing faecal samples under the microscope by candlelight. The night air of the rainforest is humid there is a damp smell to match. Cicadas buzz smoothly in the background, whilst ‘Blame it on the Weatherman’ (by B*Witched) is playing from our small speaker.
The wet season in Madagascar is over the British winter. I was told in 2013 to avoid this season and so planned to come to Marolambo in May-June.
During the wet season in Marolambo, roads become un-driveble, and walking paths become muddy and arduous. Despite being here in the dry season, today was the first day it hasn’t rained and it’s been glorious!

We are as remote as can be. Hannah has spent the evening taking me through the expedition medical kit which has been planned to cover every emergency possible. It would take a minimum of 4 days (weather permitting) to reach the nearest hospital in the case of an emergency, so the kit really has everything in it up to performing minor surgery!

Since returning from Madagascar in June 2015, not a day has passed that we haven’t been planning every detail for this trip. It has been so worth it (even in the constant rain).
Prior to Marofatsy we visited the main town of Marolambo where we spent two days planning and meeting the chiefs (traditional chiefs, official Chiefs, medical Chiefs and school Chiefs). Sleeping in the Priest’s hut was just as surprisingly luxurious as last year (hot water and toilet with a seat).

We were joined by the village chiefs (official and traditional) and head teachers accompanied by many village faces looking through the windows. Dr Alain (head of Neglected Tropical Diseases in Madagascar) gave an introduction about our project in Malagasy, the Chiefs blessed the project, and the team and I warming thanked them for their hospitality.

Research day 1: education on schistosomiasis and hand hygiene preceded the study. We divided the school but into several ‘stations’ through which the fifty children (aged 5-14) would rotate through.
Daniel, Zo, Emmanuel and Dr Alain completed the questionnaires with each child (assessing the impact of schistosomiasis in their daily life),
Jamed and Corty measured each child’s height and weight, Hannah performed ultrasonography, and Steph and I took blood to test for anaemia and malaria.

We had hoped to run through 25 children each day but the first day had gone much quicker than planned; we had only 19 children left for day 2 meaning extra time for faecal and urine analysis!

Our third and last day involved treating every child in the village for schistosomiasis via ‘mass drug administration’ as advised by the WHO. This was completed by Dr Alain and the Malagasy side of the team. Many pictures with the village and videos (including the use of a drone) were accompanied by the sounds of a hundred screaming children who had received their Praziquantel – this marked the end of Ambohitelo.

Three hours along a very muddy (but sunny!) route took us into the larger village of Marofatsy. A much more efficient day 1 of research meant that we performed research on all 50 study participants on the first day. Day 2 in Marofatsy brings us to the day of writing. Poo smearing in the morning was overcome by sunny weather and knowledge of a local waterfall (photos to come)! Well worth it and a very well received break! We have completed a third of our research and have 4 more villages, 200 more children to work with and we love it.

The reason Hannah has been taking me through the medical kit is because she will be leaving with Steph in two days to return back to England for other commitments.

Every child in Marolambo whispers Stephanie’s name – she is becoming the most well known person in the district. She even managed to make children laugh when they have their blood taken?!?!?!?

We are now in the swing of things, have gotten used to the long drops and feeling dirty, and can distinguish the different varieties of rice for breakie, lunch and dins (I must learn how then make it taste so smokey!). James and I are beating out initial infections and coming to the end of our courses of antibiotics and turning a corner health-wise. The team are all well, in great spirits, and having a really fun time. The research is filled with laughter amongst team, children and locals.

Everyday of work for this expedition was so so worth it. It’s beautiful, serene, peaceful and people are wonderful and their way of life is extremely humbling, an honour it is to be welcomed into these tribes and get a glimpse of how they function in one of the most isolated parts of the world.

I am so glad that both Stephanie and Hannah joined the expedition – the MadEx team and children of Marolambo have been much better off for it. Vohidamba, Betampona, Ampasinbola and Marofatsy to come, as we continue further into the bush.

Sampling Malgasy life

A river crossing in a hand-carved pirogue took us to the foot of the village of Vohidamba. As usual we appeared to be the centre of attention, though this time the centre of thousands of people’s attentions; Vohidamba is a large village.

All eyes on us as we arrive in Vohidamba
All eyes on us as we arrive in Vohidamba

We began the usual process after introductions: hand out urine pots, receive filled urine pots and then exchange them for stool pots and a sweet, expecting to be in possession of stool samples by the following morning.

This time was different though; within about 30 minutes, all the children apart from one had managed to produce a sample and return it. As if the entire school should produce a stool sample on demand like that!

We climbed to the top of the village with all of our precious, fresh samples and arrived at the CSB (basic health centre). The CSB was at the top of a steep hill and I found myself questioning the suitability of its location – you’d have to be pretty fit to be in with a shot of receiving medical attention!

We were welcomed by a lovely young girl who was a newly qualified nurse from a city in the East.  She was in charge of the CSB and also kindly offered to host us for three days.

We spent the day performing our various tests and preparing samples for microscopy, finishing just in time for a dinner served on the floor of the nurses hut; boiled chicken, rice and green leaves with tiny shrimps from the river that you just ate whole.

It suddenly dawned on me why these ‘green leaves’ that we were so eating so often never had a specific name.  I’m pretty convinced that the locals just go and pick some random green leaves from outside and boil them in water as a way to make rice more exciting.

It was a special evening and one that I hope never to forget. The boys and I were pretty content with sitting back and quietly observing the interactions between our two Malagasy team members, the guide from Durrell and the nurse. It suddenly felt like such an overwhelming privilege to be in this situation and in this company, something that one could never experience as a tourist. I will really miss hearing Malagasy being spoken between friends when I return to the UK.

The next day we walked to Betampana which was our final village. We planned not to stay there overnight, but just collect all the samples in one morning (now that Vohidamba had shown us it was possible to collect poo after 10 minutes notice of needing it) and deliver our education programme.  This school was calm and well organised. The parents and teachers stood at the back and seemed extremely interested to hear the education programme that our Malagasy team members (Daniel and Anjana) delivered so well.

Walking to Betampana
Walking to Betampana

We made it back for lunch which was delayed as the nurse was busy delivering a baby.  We didn’t mind waiting though as we sang the Vengaboys outside the hut, initiated by Daniel of course.

We processed the samples and it was a phenomenal feeling knowing that we had handled samples for the last time that trip!

A selfie to celebrate finishing the last lot of kato-katz
A selfie to celebrate finishing the last lot of kato-katz

It was time to leave Vohidamba and make the long walk back to Marolambo, through all the villages that we had stayed in along the way.  We assembled a great team of porters and said our goodbyes and thank yous.

Our Durrell guide was given a chicken by a local villager as a thank you which he ended up carrying in his hand for the entire walk home.  It seems like you’re not a true Malagasy until you can handle a chicken with ease.

Durrell guide holding his chicken
Durrell guide holding his chicken

It was a stunning walk but a scorching hot day which I was acutely aware of seeing as though I was in charge of safety. When we finally staggered into Marolambo that afternoon, we’d all had it, though we all seemed to be in good health. We slumped in our chairs as we ate a big rice meal and then felt like we could sleep for a long while.

We had made it back to Marolambo!
We had made it back to Marolambo!


Getting the helminth out of Tana

We woke early and hopped into a taxi brousse. The driver played a tape with a mix of Malagasy and French songs, before the likes of Whitney Houston and Elton John took over.  We stopped overnight in Andasibe and squeezed in a night walk in the rainforest where we saw some amazing lemurs. Eventually, we arrived in Mahanoro in time for dinner The next day and headed to the local restaurant ‘J’adore’.  After a bite to eat, we joined in with some karaoke and had some good dance offs with locals. One of my favourite moments so far was when Dr. Alain took the mic to blast out a French song.  He told us that we we good dancers but I think he was just being polite.

The place we are staying in is called Tropicana. The sign at the entrance has a fantastic spelling mistake which describes it as a ‘Bungalove’ rather than a bungalow.

The next day, after a classic Malagasy breakfast (baguettes that disintegrate when you touch them), we left to meet the head of medicine for Mahanoro. Dr. Alain presented our plans in an attempt to win him over.  With so many introductions on this trip, we have learnt that meetings seem to follow the same pattern.  They begin with 10 minutes of stern faced interrogation before a critical moment when we deemed to have good intentions and are trustworthy. After this  moment, there’s an eruption of excitement and we are suddenly asked to come and meet yet more people.  We were taken to meet the head of education for the area and went through exactly the same process with him.

The next day, we met with the headteacher of the school in Mahanoro that we hoped to test. After briefly testing our intentions, she summoned 50 children to line up outside her 

  office. They greeted us with a a group ‘bonjour’ and a round of applause. What a privilege. The head of education explained what we needed – a poo sample and a wee sample. The explanation was given in a fantastically over-the-top way, with brilliant actions to accompany his words.  The children found this absolutely hilarious. They must think that we foreigners are very odd, coming to Madagascar to collect these samples from them! We left sample pots with the children and they filed away back to their classes in an impressively ordered way. 

I had shivers soaring through my body and struggled around the market in an attempt to help buy some vital things for our research. By the time we made it back, I was exhausted and had a pretty high temperature. I woke the next day determined to go to the school with the boys and help with day one of the research. It quickly became apparent that I was fooling myself and reality hit. It was really hard waving goodbye to the boys knowing that I’d be completely missing out on a day of research but a horrendous day in bed told me that it was the right thing to do. They returned and looked after me really well, very grateful to have them!

Fortunately back to good health today and ready to get stuck into work. Due to leave Mahanoro tomorrow and head into the extremely isolated Marolambo district for the bulk of the research.  Can’t wait!


A journey of serendipity

I write from an Arriva Trains Wales carriage, armed with a coffee and on my way to Herefordshire.

It’s taken a long time to get to this stage. We’ve fired off countless heavily caffeinated emails from Anthony’s living room over the past year and arranged meetings with experts all over the country. I have spent car journeys daydreaming about the trip (with James and Anthony warbling to a background soundtrack of The Lion King), but it has always felt like something that was a long way into the future.

And now, with three weeks to go, it’s all getting a bit real. Booking flights has made it feel like we’re going. I can’t believe we’re actually going.

Today I began to think about the things we’ll need out there. Number one on the list: passport. Aha, now that was something I hadn’t seen since February.

Feeling like a complete mug, I called up Her Majesty’s Passport Office to arrange a replacement; yet another lesson learnt from all of this. It’s easy to forget the basics and be swept away with impressive things like communicating with WHO leaders.

I’m spending the next four days on a course, learning how to be a safe Medical Officer for the expedition. It’s a course designed for doctors but hey, we’ve spent most of this process feeling a little out of our depth and it’s something that I have become quite accustomed to.

It’s been hard work, but now I understand what it takes to organise an expedition. I’ve developed those cliché CV-boosting skills, as well as the ability to compose comprehensible emails at 3am and reel off a three-sentence synopsis of the expedition in my sleep.

With Anthony’s self-assurance, James’ charm and Steve’s experience, we’re a pretty fab team. A team that has used the word ‘serendipitous’ so many times that I was forced to Google what it actually meant but wow, what a journey. Something I’d recommend to almost anyone… and we’ve barely even started.

Written by Hannah Russell (Medical Officer, Madagascar Medical Expedition 2015)