Australian Jim Callahan is currently volunteering in Madagascar alongside his wife Vanessa Andean and other members of our WHO Surgical Safety Checklist Team. Here he shares her recollections of their second week in-country.

Week 2 was spent charting northern Madagascar in the Cessna and visiting 4 coastal hospitals, some in a post-cyclone state.  A lot of flooding but happily not too much wind damage to houses.  Flying in a light plane with a rising sun, at low altitude over a breathtaking landscape is a fabulous way to travel, particularly when the alternative is Madagascar’s torturous roads.

It feels like we’ve taken ‘fly-in, fly-out’ to a new level of extreme. I use the term airport with a bit of generosity too, as on occasions we’ve landed on unfenced open fields, and the underside of the Cessna is left with a veneer of Zebu (local cow) dung sprayed along its belly. At one particular airport, there was 1 man on the airstrip, and in the Arrivals shed, 1 dog. Another airport had a functioning railway line running straight across the tarmac!. We were collected by the hospital director in the ambulance, a well-used troop carrier using an Australian-made 2-way radio and external antenna. The transfer to the hospital included a river crossing and roads consumed by mud. It was a challenge to stay in our seats, you certainly wouldn’t want to be a patient on a stretcher on these roads. A quick breakfast of coffee and beignet de banane (fried bananas) in a dark and smoky hospital cafeteria can be had for under $0.20 cents per person. Melbourne brunch it ain’t, but it’s certainly authentic and satisfying, and exactly the type of experience I’ve been getting a kick out of.

Each hospital follow-up session elicits a different response, some surgical teams receptive and some clearly not wanting us to meddle, reflective of the different dynamic and personalities in each institution, and according to our Malagasy doctor, the cultural differences between Malagasies from different regions. Health care workers continue to do a remarkable job with very limited resources in this country.

The days involving 2 hospital visits and 2 flights are pretty demanding, but this is always tempered by one’s turn in the front seat alongside the pilot. Last week I had my first ever immersion experience at the controls of a plane. After hours asking the pilot about every instrument in the cockpit, I could differentiate my vertical speed from air speed, and flight-path coordinates from my manifold pressure. He explained the principles of the rudder and wing flaps and then under close supervision, I had a little go myself, both hands on the ‘yolk.’ It was of course new and special, and so different to a car, as you have to regulate vertical speed, staying level, airspeed and direction through the yolk.  There’s no autopilot and I was surprised how fatiguing all the focus was.

The English-speaking world has evidently donated huge volumes of clothing and I’ve made it a project of mine to spot unusual or noteworthy items being worn by locals. It appears that the correct fit is prioritised over whatever the garment actually says.  Given literacy rate is about 65%, and English is more or less non—existent here, there’s a good chance most people have no idea what is written on their clothing. My favourites to date include a strapping young guy wearing a fitted muscle T, swaggering along a street in the capital; on his T-shirt read,  I love 1 Direction. And a homeless man sifting through rubbish in a skip wearing a hoodie emblazoned with ‘University of Southern California Grad Program’.

For the piston heads I’ve spotted some very unusual cars: a 2 door Peugeot 504 coupe, a Renault Gordini Dauphine, and a pink R33 Nissan Skyline, all in the capital.

By the time you read this we will be into our 3rd and final week of surgical safety checklist training follow-up, which will take in 6 hospitals throughout southern Madagascar, 2 of which Vanessa and I visited last year, so it was lovely to pick up the phone and have the directors of these hospitals recognise our voices. We’ll be on a plane every day now until Sunday night when we arrive back in Melbourne, Australia.  It’s going to be a rather big week.