Australian anaesthetist Vanessa Andean is currently volunteering in Madagascar alongside her husband Jim Callahan and other members of our WHO Surgical Safety Checklist Team. Here she shares her recollections of her first week in-country.

Greetings from Antananarivo!

I’ve made it to the end of the first of 3 weeks on our annual volunteering jaunt, Jim is arriving tomorrow for the final 2.

This is our third visit to Madagascar so it’s beginning to feel very familiar.  The project this time is a follow-up of the teaching we did last year with Mercy Ships, trying to get local operating theaters to run a quick surgical safety checklist before every operation.  Last year we visited 4 hospitals in 4 weeks in the centre and west of the country, traveling by road.  Most of the other hospitals in the country were taught by another team during the year. This time we’re aiming to visit 14 hospitals in 3 weeks, all over the country.  It’s big, with some utterly atrocious roads, so the plan has been to travel by small plane.

We were initially planning to come in February but were advised to delay until March to avoid cyclone season (not healthy for 4-seater planes!). So of course the news that greeted me as I stepped off my flight last Sunday was that the island was awaiting the arrival of – tropical cyclone Enawo. Not great news for us but even worse for the people whose crops and houses are vulnerable to weather at the best of times.

By the time I arrived our illustrious leaders had already re-jigged the itinerary so that instead of heading north into the cyclone we would go west and south, with the aim of racing back to the capital by the time the storm hit. So my work day on Monday involved turning up at the airport at 5:30am to be weighed along with my bag and then squeezed into a tiny little aeroplane along with our Malagasy doctor, our English boss from Mercy Ships, and our very calm and organized Swiss pilot.  Everything and everyone fit perfectly with not a centimetre to spare – just like going on holiday in a flying Fiat Uno.

Flying out at dawn over the highlands of Madagascar is a truly amazing experience!  We were only 4,500 feet off the ground – about 1.5 km – so the detail of villages, ravines, rivers that we could see was incredible. After about an hour and a half we arrived at the coast of the Mozambique Channel and landed on an overgrown airstrip with a shed beside it, and the one and only hospital ambulance (a clapped-out Land Cruiser) eventually arrived to lurch us away through the dust to the hospital.

By this stage it was 9 am and everyone was drenched in rivers of sweat – all ready to be met by the very enthusiastic theatre team of 6.  They had been saving up an operation for us to see, so we were bustled into the operating theatre – a tiny dark room with one glorious (albeit struggling) air conditioner.  They ran their safety checklist with great theatricality and then got on with the job at hand – taking out an enormous bladder stone from a man who’d had trouble wee-ing for a few years (understandably as it turned out). The whole procedure bore a remarkable resemblance to a Caesarian section – awake patient under spinal anaesthetic, a bit of a tussle to get the head (or in this case the stone) out, and the end product was then weighed (800 grams!) and handed triumphantly to the patient.  Applause all round.  Then we lurched back to the airstrip to zoom off to our next hospital.  Just as we were getting strapped in a bloke on a motorbike raced up to the plane with an enormous bag of oranges for us to take with us. A true Fiat Uno would have had roof racks for them but as it was we managed to squeeze them into the cabin around the rest of our stuff.

We got to our second hospital by mid afternoon, more rivers of sweat, this time no theatre case so we attempted to run a little simulation – pretty chaotic, not much clue about the checklist, a bit disappointing but not entirely unexpected. Slept in a little hotel by the beach and then leapt up for another early flight.  By this time I was having trouble believing I’d only been in the country for 36 hours.

A couple of hours’ flight to Fianaratsoa, in the south of the central highlands, and our glorious weather gave way to some clouds and rain.  The pilot was beginning to get jumpy about the cyclone which had already arrived in the north so he left us there so that he could get the plane back to its hangar in the capital in time.  Another hospital visit, then we found ourselves a man with a van to start the journey back by road over two days with a final hospital visit and early morning Caesarian section (for real this time) thrown in for good measure.  Happily the expected cyclone conditions didn’t eventuate along our route, just a lot of very heavy rain, but the north and east of the country have suffered lot of damage.  We’ll be going there next week and not very sure what awaits us.

Needless to say I’ve spent the weekend mostly asleep!

So there you have week 1. All is well.

Much love to everyone,