Madagascar
Report 1
Reporter: Kate Mandeville
Contact at destination:Dr Rakoto-Ratsimba, Chief of Urology Services
Year of visit 2005-6
Country: Madagascar
Institution: CHUA, Antananarivo, Madagascar
Departments : Urology and A&E
Work / Study undertaken
Urology: Assisted in theatre 3 mornings a week, followed ward rounds, put in suprapubic catheters, clerked new referrals – quiet over Christmas as elective operations cancelled for two week holidays
A&E: Spent most of my time here over Christmas and New Year, which was fantastic. Many emergency operations (numerous obstructions, trauma, appendicetomies) plus interesting cases such as man struck by lightening, ruptured ectopic pregnancy, machete attacks, thumb taken off by industrial machine, gangrenous foot.
ITU: If too much surgery, you may want to pop next door to the A&E department where there is a well hidden ITU department. I brushed up on my medicine with a tetanus case, viral hepatitis, myasthenia gravis, and many strokes with very good signs.
Description of the service and department
It is a public hospital so the government pays the dr’s wages and overheads but the patients pays for all material needed during their stay. This meant operations were frequently delayed for several hours whilst relatives tried to get enough money to pay for the suture material (the most expensive item in the hospital, so make sure you don’t use too much whilst closing up – “il faut economiser”, I was told!)
The doctors are very skilled but frustrated at the lack of resources and new technology. I had great respect for them as most had trained in Europe but had chosen to come back to work in Madagascar.
Description of the destination In the centre of Antananarivo. Easily reached by either foot or taxi.
Were the local people friendly? Did you feel safe and if not why not?
The Malagasy are extremely friendly people – very gentle and non-aggressive. I made many friends just due to the sheer good nature of the locals. I felt safe during the day, however there is a bad pick-pocketing problem in the city. Keep an eye on everything – one of my consultants had her stethoscope stolen in a bus! I didn’t feel safe after dark – not many people out and little lighting. Take a taxi if walking far to a restaurant.
What did you do in your spare time? Is there anything that you would particularly recommend others to do?
Leave time for a trip down to the south at the end of your visit. Fly to Toliara, an Indo-Malagasy mix which is like something out of a film. Go to St Augustine’s Bay and swim in the natural swimming pool. Go onto to Isalo National Park and walk to the Canyon de Makis (Lemurs), stopping in on some sapphire merchants in the neighbouring Wild West town. Then relax for a couple of days in Antsirabe, which was set up by Norwegian missionaries and has many incongruous white blond children running around it.
What time of the year were you there? What was the climate like? November to February. Hot during the day, with some tropical storms towards the end of my stay. Bring a jumper and a raincoat.
What was your accommodation like? Hotel Mellis – very clean hotel with friendly staff near train station and lots of restaurants
Was it provided? No
If not who arranged it? I did, via email through the Brandt travel guide – only hotel to respond to my email.
How much did it cost? £10 per night, 10% discount from normal price due to 6 week stay. If possible, pay in instalments by cash – I felt I lost a lot of the benefit of the discount at the end of the stay through the fee for card payments!
Did you enjoy your visit? Yes it was everything I hoped it to be and more! I fell in love with this country and people, and would urge anyone considering it to jump at the chance to go.
Did you find the visit useful medically? - in what way?
Yes – I saw and assisted in lots of acute surgery. My examination routines and history taking probably atrophied if anything, as there’s not the formal teaching culture like in the UK and the language gets in the way a bit. But you’ll pick up more than you think as you are seeing so much. Do ask to be presented (definitely necessary) to other chefs de service, who are always more than happy to have the chance to practice their English whilst showing you some interesting cases.
Has it improved your French? Definitely – my confidence in speaking improved tremendously. Make sure you learn your surgical instruments vocab before assisting in theatre though!
How has it increased your knowledge of French culture? In a way – there is a strong French influence still evident in Madagascar and many expats in Tana. The patisseries rival anything seen in Paris!
If you went back would you do anything differently?
Take more mosquito protection – terrible outside of Tana, especially when hiking. I would try to learn a little Malagasy before I go – even a little is really appreciated and most ward rounds are completely in Malagasy. Most importantly, take a light white coat – all doctors wear them as routine in the hospitals and you won’t be distinguished without one. Alternatively, it was very cheap to get a cotton one made up over there in the hospital laundry.
How did you get there? Air Madagascar from Paris. There is a UK office. Possible to book BMI flights to Paris through them. If book internal flights at same time, you receive a 50% discount.
What was the approximate total cost? £2500
Is there any other information that you think may be useful?
There’s a consulate in London (Shepherd’s Bush) where it’s easy to get a study visa in less than thirty minutes. The two main travel guides are Brandt (probably need to order it) and the Lonely Planet. Brandt caters for more upmarket tourism, but is more informative, and has some lovely stories about Madagascar. Lonely Planet is more suitable for travelling on a student budget, so vary between the two.
Report 2
Reporters: Angela Morgan & Asha Giora
Contact at destination: Prof. Ramahandridona, Chef du Service S.M.M.E.
Year of visit: 1996
Country: Madagascar
Institution: Befeletanana Hospital, 101 Antananarivo, Madagascar
Departments: Diabetes department, Paediatric department
Work / Study undertaken: Study into the management of diabetes in Madagascar work in the paediatric department
Description of the service and department: Very basic but doctors are very friendly and helpful
Description of the destination: On one of the hills above the capital (20 minutes walk from the centre) with amazing views to the east
Were the local people friendly? Very - numerous offers of meals, staying weekends with medical students, families etc.
Did you feel safe and if not why not? Yes - slight security problem in Antananarivo but if you’re sensible OK.
What did you do in your spare time? Visited ancient burial grounds! and traveled to other towns around the capital. Met up with the medical students. Little opportunity for going out at night.
Is there anything that you would particularly recommend others to do?
Périnet reserve - to see lemurs and chameleons in the wild - about two and a half hours by taxi from the capital
Île St Marie - amazing desert island off the east coast - fly from capital
What time of the year were you there? What was the climate like? March and April. End of rainy season in March. Very hot all the time - 32 degrees centigrade but not humid due to mountainous area.
What was your accommodation like? Family house
Was it provided? No
If not who arranged it? Selves
How much did it cost? £5 per night plus £3 per meal - pricey for Madagascar but benefits of staying with a family are numerous
Did you enjoy your visit? Yes amazing
Did you find the visit useful medically? - in what way? Lots of tropical diseases seen
Has it improved your French?
How has it increased your knowledge of French culture?
If you went back would you do anything differently? No
How did you get there? Air France from Trailfinders (London) £774
What was the approximate total cost? £1500
Is there any other information that you think may be useful?
We had problems extending our visas from the he thirty day tourist visa due to a new law having just been passed. However even the consulate over here was unaware so they couldn’t have warned us - so be prepared and patient!
Lonely Planets Guide is excellent - most info is up to date.
Report 3
Reporters: Katherine Wight & Jonathan Norris
Contact at destination: Dr Ravelomamy Director General
Year of visit: 1999
Country: Madagascar
Regions: North - Diego Suarez, South - Antisirabe
Institutions: L’hôpital Regionale, Antisiranana, BPP 101, Madagascar. Lutheran hospital, Antisirabe
Departments: Antisiranana - wards and A & E, Antisirabe - Opthalmology department
Work / Study undertaken: Antisiranana - mostly in the A & E department - two days in leprosy colony. Antisirabe - assisting in theatre
Description of the service and department: Antisiranana - basic local hospital major impute from senior local medical students. We worked in wards and A & E. Antisirabe - good facilities
Description of the destination: At the very north of Madagascar. Hospital situated right on the coast with fantastic views of the sea.
Were the local people friendly? Could not have been friendlier
Did you feel safe and if not why not? Very safe
What did you do in your spare time ? Beach, National Parks, walking, eating out
Is there anything that you would particularly recommend others to do? Montagne D’Ambre and Ankarana national parks situated on the outskirts of Antisiranana
What time of the year were you there? What was the climate like? August to October - very fair with occasional rain
What was your accommodation like? Hotel Chez Layec Antisiranana (opposite FJKLM Church) Fantastic - very cheap, helpful staff, clean and very good breakfasts
Was it provided? No
If not who arranged it? Selves - guide book
How much did it cost? £3 a night including breakfast
Did you enjoy your visit? Very much so
Did you find the visit useful medically? – If so, in what way?
Has it improved your French? Yes
How has it increased your knowledge of French culture?
If you went back would you do anything differently? Stay for even longer!
How did you get there? Flights : London - Johannesburg - Tana - Antisianana (internal)
What was the approximate total cost? £2500
Is there any other information that you think may be useful? Make sure that the elective is planned well in advance.
Report 4
Reporters: Philip Doust, Christelle Evans and Elizabeth Yeates
Contact at destination: Dr David Mann, Davidmann@uuplus.com
Year of visit: 2004
Country: Madagascar
Institution: HVM, BP 12, Mandritsara 415, Madagascar
Departments: All
Work / Study undertaken: Clinical placements in general medicine and surgery, and opthalmology
Description of the service and department: Very well-resourced hospital and friendly staff. Good teaching. Small rural hospital. Christian mission hospital.
Description of the destination: Small town very little infrastructure-a good experience of the simple life, some nice hills and rivers around where we went for walks at weekends
Were the local people friendly? Yes very, we were invited by the doctors/nurses for meals, games, songs, church, bible studies, videos etc.
Did you feel safe and if not why not? Yes although going out alone after dark was not recommended-not that there was really anywhere to go!
What did you do in your spare time? Bike rides, social activities, reading, cooking, shopping, cleaning. We went travelling at the end to some beach resorts and a national park.
Is there anything that you would particularly recommend others to do? Nosy Be is a beautiful island and very safe. You can go snorkelling and see lemurs!
What time of the year were you there? What was the climate like? June-September-the dry season. A good time to go-weather is like good British summertime!
What was your accommodation like? Guest house-very good, self-catering.
Was it provided? Yes
If not who arranged it?
How much did it cost? £7.50 a week (food very cheap from marker-£1 a week!)
Did you enjoy your visit? Yes!
Did you find the visit useful medically? - in what way? Yes-we got do practice clinical skills on the wards and in theatre. We saw lots of the most common tropical diseases (main diseases were malaria, pneumonia, bilharzia, meningitis, gynae and obstetric problems, syphilis, lymphoma and other rare cancers)
Has it improved your French? Yes!
How has it increased your knowledge of French culture? Not so much French culture, but definitely Malagasy culture which is very unique, although we had to fly through paris and spent sme time there getting to know some of the history etc.
If you went back would you do anything differently? I would make more effort to learn Malagasy because the villagers don’t speak French!
What was the approximate total cost? £1500+money for travelling around afterwards which was about £200.
Is there any other information that you think may be useful?
The Bradt guide to Madagascar is now the most up-to-date and helpful guide!
Report 5
Reporter: Abigail Randall, Bart's & the London
Contact at destination: Dr David Mann
Year of visit: 2008
Country: Madagascar
Institution: Hopitaly Vaovao Mahafaly
Departments: all - it's a small hospital and you get the chance to see and deal with just about whatever turns up with the help of whichever of the half dozen doctors and clutch of aide-soignantes happen to be around.
Work / Study undertaken:
Attended ward rounds every morning.
Saw lots of general medicine both in clinics and on the ward (especially tropical diseases such as malaria, typhoid fever, bilharzia, all kinds of worms; also meningitis, ENT problems... etc)
I assisted in theatre two mornings a week as well as for various emergencies, and in that context performed lots of spinal anaesthesia and intubations, and also got the chance to practice my suturing.
Did on calls one night a week and also one weekend, this honed a lot of emergency medicine skills.
Description of the service and department The only surgical centre for a few hundred kilometres, patients walk or are carried sometimes for days to get there. It is a mission hospital with a specifically Christian emphasis, and there are many opportunities to share the message of the Bible with anyone who wants to hear.
Description of the destination Beautiful. A gorgeous rice paddy filled valley surrounded by lush mountains with red soil. The whole place positively moves with life be it lizards or frogs or snakes or massive gross bugs.
Were the local people friendly? Did you feel safe and if not why not? Very friendly. They didn't speak much French though. Communication was generally through French-Malagasy translation by one of the aide-soignantes. I felt safe but maybe that's because I'm a Londoner. While we were there a curfew came into force that no-one was allowed out after 10pm unless an absolute emergency in which case they should carry their papers. Apparently because of muggings. But I wasn't ever aware of any violence or threat of violence. (In Tana the capital, however, it was a different story altogether...)
What did you do in your spare time? Is there anything that you would particularly recommend others to do? What spare time?? lol. Went to church on Sundays. Helped run the youth group. Did a cycle ride into the surrounding area which was well worth doing. Spent Saturdays going to market and baking bread. At the end we took a week or so and went to Mahajunga on the west coast. It was lovely but perhaps not worth the long journey to get there (no lemurs!). We had wanted to go to Ile Saint Marie but it had been hit by quite a rough cyclone so we went to Mahajunga instead.
What time of the year were you there? What was the climate like? March. Very hot but shouldn't have been so bad, it was unusual. It was regularly hitting 34-35oC. Humid. Theatre was difficult to bear at times, I got quite faint. But it was totally gorgeous being the end of the rainy season, everything amazingly green. A cyclone had hit the country a couple of weeks before we arrived which made life difficult because the roads were badly damaged and supplies from the capital couldn't reach us - the diet was confined to what could be locally grown, ie rice and fruit.
What was your accommodation like? A self-catering house on the hospital grounds.
Was it provided? Yes
If not who arranged it?
How much did it cost?About £7 a week
Did you enjoy your visit? Very much
Did you find the visit useful medically? - in what way?In every way. There was so much opportunity to DO stuff. Which forced me to learn how to do stuff.
Has it improved your French? I think so. Definitely my medical French which didn't really exist previously.
How has it increased your knowledge of French culture? Er.... There are hangovers of the French colonisation in terms of everything being very beaurocratic...
If you went back would you do anything differently? Try and do an audit or some research which could actually be useful to the hospital but which no-one there has time to do.
How did you get there? Flew Air Mauritius London to Mauritius to Tana. Took an internal flight with Mission Aviation Fellowship (organised through the hospital) to Mandritsara.
What was the approximate total cost? About £1500 including flights, food, accommodation and a week's holiday at the end
Is there any other information that you think may be useful?
Report 6
Reporter: Anna Martin
Contact at destination: Dr Andre Damiba, Programme Director, MSI
Year of visit: 2008
Country: Madagascar
Institution: Marie Stopes International, Lot II P bis 135, Avaradoha, BP 1351, Antananarivo
Departments : Reproductive healthcare & paediatrics
Work / Study undertaken
Obstetrics: Our time was allocated equally between ante-natal clinics and the delivery rooms. In the ante-natal clinics we held our own consultations and were able to take detailed histories and examinations. We assisted in caesarean sections and and delivered babies. Working on-call shifts provided an excellent opportunity to gain confidence in the management of labour.
Paediatrics: I observed and carried out ‘suivi-bébé’ clinics (nurse-led consultations purely dedicated to washing and dressing newborn babies), attended vaccination clinics, administering relevant vaccines to infants as well as gaining practical experience in general paediatric consultations and examinations.
Family planning: Alternate weeks, I was based in the family planning centre. I learnt how to insert the contraceptive implant Implanon®, administer the contraceptive injection, as well as carrying out minor surgery in removing the contraceptive implant. The consultant was really keen to teach us and was very encouraging.
‘Outreach Programme’: During the family planning weeks I was dispatched with the medical team to remote villages to provide contraception. These opportunities were by far my most memorable experiences of my elective. The project, known as the ‘Outreach programme’, was set up by MSI and receives assistance from the Malagasy government in the national drive to reduce pregnancy rates. It involves one doctor, a nurse and a trained educator in contraceptive options, who travel to cut-off rural regions (sometimes staying a couple of nights) to deliver contraceptive services. Female sterilisation was included in the list of contraceptive options available to women utilising the Outreach services. The tubal ligations were carried out under local anaesthetic with the patient fully conscious throughout the procedure. Other services provided were contraceptive implant insertion/removal, copper coil insertion/removal, the contraceptive injection as well as vasectomies. It was a fascinating experience to see how popular this programme is in rural communities and how successful this project is.
Description of the service and department: Marie Stopes International is a non-governmental organisation present in 37 countries world-wide specialising in reproductive health. In Madagascar it works very closely with the Malagasy government in the drive to reduce pregnancy rates. It also provides maternity and paediatric services to the local population.
Description of the destination: In Avaradoha, on the peripheries of the centre of the capital, Antananarivo (Tana for short). It is best to stay in one of the hostels near the head office as it is not easily reached to by foot. We stayed at a fantastic hostel especially for French NGO workers/volunteers called the ‘Cas Départ’. Mme Hasina is incredibly friendly and welcoming. You really do feel like it’s a little piece of home.
Were the local people friendly? Did you feel safe and if not why not?: The Malagasy people are very approachable and are extremely gentle. Initially they may appear rather aloof but they are so kind and generous when you make the effort to get to know them. As for safety in Tana, we were advised not to walk around the city centre at night, as muggings are commonplace. Because of this we always took taxis at night, which is a must. The atmosphere is totally different at night. My friend thwarted an attempted pick-pocketing from my bag. She saw him walking quite happily with his hand in my bag in broad daylight and so slapped his hand (I didn’t have a clue)! As a word of warning, do keep an eye on your bag, preferably wear it on your front (even though it makes you stand out as a tourist even more). Also, it is the only country I have visited where male tourists encounter far greater attention than women, which was a relief to us girls.
What did you do in your spare time? Is there anything that you would particularly recommend others to do? In Tana (Antananarivo), shamefully we spent a vast amount of our spare time sampling the local restaurants, which were so incredibly cheap and served some of the most spectacular meals. It was also a good way to meet other people working/travelling through Antananarivo. The capital itself is overcrowded, polluted and noisy so most people only stay for a night or two if they’re travelling. Despite this, there are a few attractions worth seeing, for example the Rova (the queen’s palace) and the Marché Artisanal. Apparently the crocodile farm is excellent (we didn’t have time to go in the end) and the best time of day to go is lunchtime during their feeding.
I particularly recommend spending a couple of weeks doing the South West trail: Tana – Antsirabe – Fianar – Isalo National Park – Tuléar – Anakao. Anakao is a beautiful secluded fishing village tucked away in the South West and is the perfect place to get away to relax. Depending on the time of year, you can go on whale watching trips. There’s always good diving and snorkelling too. My favourite place though was Ile Sainte Marie – again perfect for whale watching (up until beginning of September), diving and just the most incredible postcard beaches you’ve ever seen.
Andasibe national park is great for seeing the indri-indris (basically the biggest types of lemurs). If you stay next to the park you get woken up by the call of the indri-indri and it’s just haunting. A fantastic weekend getaway. It was also absolutely freezing in August so wrap up warm.
What time of the year were you there? What was the climate like? July – October. When we arrived in Antananarivo in July, ‘winter time’ in Madagascar, it was bitterly cold and it often rained. Definitely leave room in your rucksack for a big warm jumper and kagul! By the end of October it was very pleasant, even hot on most days. I had not appreciated the size of Madagascar and hence the differing climates. The West of the island is always very hot and dry, whereas the East of the island has more unpredictable, tropical weather and can be unbelievably cold during their winter!
What was your accommodation like? During our elective in Tana, we stayed in a hostel called ‘Cas Départ’, which is accommodation especially for (mostly) French volunteers / NGO workers. It was a lovely place to meet other young people doing really interesting work in Madagascar and was excellent for improving our French conversation.
Was it provided? No
If not who arranged it? We arranged the accommodation ourselves.
How much did it cost? It was very cheap (the equivalent of £3/pp/pn). It was definitely the best accommodation around. For an extra £1/day you could order a truly scrumptious home-cooked lunch by the housekeeper, who was just wonderful. It was some of the best food I experienced during my stay in Madagascar.
Did you enjoy your visit? It was an absolutely incredible experience. I can’t praise my trip highly enough. Madagascar is such an extraordinarily diverse country with so much to see and do. One piece of advice: do leave ample time to see the island. You will end up spending a vast amount of it on a taxi-brousse, much much more than you’ll anticipate!
Did you find the visit useful medically? - in what way? It was useful medically but not quite as much as I had been hoping for. Perhaps I had expected too much from the brief experience. However, we were given the opportunity to observe and participate in such a variety of medical experiences and our medical French improved dramatically over such a short space of time. Has it improved your French? My French has come on leaps and bounds since my elective in Madagascar. We met so many other travellers and NGO workers, mostly French, which helped immensely. However, rather naively, I had not naively anticipated that so much of the working language would be in Malagasy. We spent a couple of mornings listening to the doctors conversing entirely in Malagasy with the patients, which was frustrating for us not knowing what was happening. The majority of the time however, the doctors were more than willing to translate into French for our benefit and the patients were extremely enthusiastic to converse with us in French too. I wish I had learnt more Malagasy before arriving in Tana. It makes such a big difference to the reception you get from people. They really appreciate the smallest of effort to learn their language.
How has it increased your knowledge of French culture? Yes, especially the culinary aspect! I was pleasantly shocked by the sheer amount of incredible patisseries available in Tana and the subsequent weight gain in only 3 months. One recommendation: before you leave Madagascar you must dine at the ‘all you can eat’ lunch buffet at the Sakamanga restaurant – it’s unbelievable.
If you went back would you do anything differently? I also would strongly recommend learning basic Malagasy before you start your elective. It really helped us integrate with the hospital staff and become accepted into the team. They were delighted when made the effort to greet them in Malagasy and spent a vast amount trying to teach us more advanced Malagasy – which proved to be highly entertaining for the department!
Take your own scrubs and white coats out to Madagascar with you.
How did you get there? We flew with Air France for just over £1000 for a return journey. It was extremely expensive, especially if you want to travel by flights internally, which are also tremendously pricey.
Internal flights need to be booked through Air Madagascar. If you have reserved your international flight with them you receive a 50% reduction in ticket price for internal flights. I have to admit it really was a real luxury to take a 1 hour flight to Tuléar from Tana, which takes over 12 hours by taxi-brousse!
What was the approximate total cost? £3000
Is there any other information that you think may be useful? The most useful travel guide book to get hold of is the French edition of the guide ‘Routard’ for Madagascar. Out of all the guides this was the most comprehensive in terms of providing the most up-to-date information on destinations, prices, accommodation and realistic information on what to expect.
Taxi-brousses always break down. Also they don’t leave until the whole bus has been filled so don’t be the first to buy your tickets or you could be waiting another 5 hours to leave until they find more people.
Buy a mobile and pay-as-you-go SIM card. Invaluable for keeping in contact with family at home/new friends/booking hostels. Very cheap (think the phone was £4).