As 22-year-old farmer Joseph neared the end of a 12-hour walk towards the Africa Mercy®, docked in Madagascar’s port city of Toamasina, he was reminded of the many years of social isolation he had suffered due to his cleft lip. “If I had friends, I wouldn’t have walked alone,” he said. “I feel alone all the time because people don’t want to be around me. I can’t even hire labourers to work on my farm.”
In Madagascar, where access to surgical care remains out of reach for many, living with conditions like a cleft lip can shape a person’s entire life. Joseph grew up with big dreams, but being born with a cleft lip became a significant obstacle. “I wanted to go to school and one day, become a politician…but I couldn’t realise my dream because of this condition,” he shared.
In 2016, while Mercy Ships was in Madagascar, Joseph’s aunt tried to persuade him to travel to the ship for free surgery. However, he was terrified of leaving his village for the first time. Years later, in 2024, Joseph bravely walked into the Africa Mercy’s operating room to reclaim his sense of belonging through healing.
Revisiting a Calling To Serve
Dr. David Chong, an Australian reconstructive plastics surgeon who performed Joseph’s surgery, first came to Madagascar in 1996 as a young doctor on the Anastasis. “I remember being very moved emotionally the first day I walked onto the ship,” he recalled. “It birthed in me a desire to do more in global health.”
Over the years, Dr. Chong continued to volunteer with Mercy Ships and other NGOs in Madagascar, returning multiple times as his career progressed.
In 2024, he returned to Madagascar as an expert in cleft lip and palate repair surgery – joining Mercy Ships once again. He explained why adults like Joseph often live with unrepaired cleft lips for many years in the island nation. “Madagascar faces both widespread poverty and a transport system that leaves many communities isolated,” he said. The World Bank classifies Madagascar as a low-income country (LIC) with over 80% of the population living below the poverty line. This economic hardship limits access to healthcare, resulting in delayed treatments and poor health outcomes for many.
Despite these systemic challenges, Dr. Chong emphasised the country’s untapped potential, particularly its dedicated medical workforce, “It has a poor health system but combined with extremely talented health professionals.”
In 2024 as the Africa Mercy continued to offer direct medical services in Madagascar, Mercy Ships and Operation Smile collaborated to train and mentor local health professionals in comprehensive cleft care. Through Mercy Ships’ Education Training and Advocacy program, Malagasy surgeons, anaesthetists, nurses, nurses providing nutrition and speech therapy, and a dentist — who were volunteering in the country with Operation Smile — came on board for specialised training. Dr. Chong played a key role in leading this training initiative.
Surgeons With Servant Hearts
Seeing patients like Joseph on board the Africa Mercy did not surprise Malagasy Paediatric Surgeon and Professor Romain Raherison. His oldest cleft lip patient was a 66-year-old woman.
“We asked why she still wanted the surgery at her age, and she responded, ‘For 66 years, I wanted to wear lipstick and makeup like all the women,'” recounted Professor Romain.
Since becoming a surgeon in 2008, Professor Romain has devoted his career to performing surgeries in Madagascar’s capital and remote parts of the country as a volunteer with NGOs like Operation Smile.
Yet, he remains acutely aware of the gaps in the system. “We don’t have enough Malagasy surgeons who really master cleft lip and palate surgery,” he said, highlighting one of the challenges confronting the healthcare system.
Professor Romain relocated with his family to Toamasina to set up paediatric surgery in a public hospital and teach at the faculty of medicine.
“His salary is likely to be just a pittance of what we would consider appropriate for someone of his standing, yet he still has the call,” said Dr. Chong. “He’s shown with his life where his heart is.”
Like Professor Romain, Malagasy surgeon Dr. Joelle Horace also volunteers with Operation Smile and knows the plight of cleft lip and palate patients. “It will cost around $400 for a complete treatment for cleft lip, and it’s more than what they earn in a year,” she explained.
A colonel and single mother, Dr. Horace juggles her work and motherhood, while still finding time to volunteer.
Despite these glaring challenges, these surgeons serve their people with a heart and vision. “Not only do we change lives, but we fulfil dreams,” said Dr. Horace.
While patients like Joseph received life-changing surgeries on board the Africa Mercy, surgeons like Dr. Joelle and Professor Romain joined Dr. Chong in the operating room – picking up new techniques to elevate their practice. “Dr. Chong is an icon. He’s the reference for cleft lip surgery,” said Dr. Horace.
“I just learned a new technique…his own technique, and he taught me,” added Professor Romain.
Building Comprehensive Cleft Care in Madagascar
The training also encompassed essential aspects of cleft care like nutrition, speech therapy, and dentistry. This holistic approach to strengthen Madagascar’s healthcare system exemplified what Dr. Chong described as diagonal development. “We’re looking after this patient well, but we’re [also] looking for a way to create long-term change,” he emphasised.
This mission is deeply personal for Paediatric Nurse and Nutritionist Nivoharilala Niry Rakotoarimanana, who was part of the training. She’s passionate about finding solutions to reduce malnutrition in Malagasy children, particularly children with cleft lip and palate. Niry is married and has two boys. She works at a military hospital and volunteers with Operation Smile to care for cleft lip and palate patients who cannot afford care in Madagascar.
While working alongside volunteer nutritionists on board the Africa Mercy, Niry learned how to support patients with proper nutrition before and after surgery. “I really gained knowledge; not only theories, but we have been able to participate in work,” she said.
Another critical aspect of comprehensive cleft care is speech therapy. Surgery is only the beginning of recovery for cleft lip and cleft palate patients – a speech therapist’s expertise is required to restore speech fully.
“But in a place like Madagascar, there are no speech therapists,” said Dr. Chong. “So how can you do comprehensive care in Madagascar if there are no speech therapists?”
Alida Rasoamanantena is determined to answer that question. A university student in Madagascar studying language sciences and an aspiring speech therapist, Alida began volunteering at just 18 years old. With no speech therapy programs or training institutions in Madagascar, she turned to organisations like Operation Smile for foundational training.
On board the Africa Mercy, Alida found mentorship under Australian Volunteer Speech Therapist Christina Petherick, who guided her in advancing her skills in speech and language pathology. “I had time to explore multidisciplinary practices,” she said. “And I am so grateful to my mentor, Christina Petherick.”
The Ongoing Impact of Collaborative Training Programs An obstetric fistula clinic in Madagascar brings hope and healing to Malagasy women who don’t have access to affordable obstetric fistula care. Staffed by Malagasy health professionals trained years ago in partnership with Mercy Ships, it exemplifies the sustainable impact of collaborative efforts in healthcare such as Mercy Ships’ ETA programs.
“The only way that change really happens is through knowledge…empowering people and advocacy. In this role of global health, it’s about giving voice to people who are not heard,” said Dr. Chong. “I think there’s no greater way of showing love.”
Joseph left the Africa Mercy with a new smile, ready to embrace the dreams he had once buried. But his story is only one part of a multifaceted mission – strengthening healthcare systems and equipping local professionals to continue this life-changing work. By empowering these individuals, Mercy Ships is creating long-term, sustainable change that will ripple across Madagascar for generations. Learn how you can make an impact with here
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