Waite for it…

Monday (October 12) was our first clinic day in Antsirirabe (not to be confused with Antsirabe, where the Lutheran Hospital is located). After a two-hour drive on OK roads, we went off-road for the last hilly and bumpy final 7 km that took us to a Lutheran Church where the local pastor said 800 people were waiting for us. A team had supplied a clinic here in September, so word must have gotten around. They were gracious and patient as we set up and began to see patients.

The basic flow: (1) sign in, with weight and age; (2) see a nurse for BP and triage (what’s your main concern today?); (3) see a doctor, or Joanna, the NP working here for the year; (4) pick up your prescription at the “pharmacy.” “Pharmacy” is a table with all of our meds spread out, waiting to be put into bags as prescribed. I think we had three triage stations, three providers, and seven of us working in the pharmacy. The other two pastors with us directed traffic from one station to another.

We saw 607 patients that day before we closed up shop at 4:30. I worked as a runner in the pharmacy, taking filled pill bags to Jeanelle, our pharmacist, for a final check, who handed them off to an interpreter to deliver to the patient. I helped restock all the stations where prescriptions were filled. We gave out antibiotics, antifungal cream, analgesics, and many, many, many vitamins.

I thought we were doing very well, until at the end of the day we still had a stack of unfilled prescriptions! Where did they come from? We would need a better system for the next few days. No worries – Jeanelle had a plan for tomorrow. Also, a team would come back next week to fulfill all those prescriptions.

The doctors and Joanna didn’t need interpreters, so we were able to see many patients in a short time. Plus, there weren’t too many severe cases. Mostly headaches, hypertension, asthma (all that dust we were breathing) and infections. A few were referred for further hospital care, but the hospital is several days walk away and fairly expensive. I’m not sure what happened to them.

We had some very well done zebu of supper that night, along with some Three Horses Beer, a native brew of Madagascar. After supper and devotions, we filled hundreds of bags with vitamins and other medications to help facilitate a speedier pharmacy in the morning.

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It was not, however, so easy getting up at 6 am Sunday morning.

There was a little restaurant at the hotel so Lisa and I stopped in for some coffee. The table menu said a cup of coffee was 3,000. Three-thousand what? Ariary, the currency of Madagascar. The exchange rate is about 1 to 3150, so roughly a buck. Tasted like instant to me, but it was OK.

We loaded into the vans and drove about five minutes to a little breakfast place where we had juice, coffe, rolls and omlettes. Not too bad.

Because of the drive ahead of us, we weren’t able to attend church. We did stop to peek into the back of a service to hear some of the singing at a Lutheran church. But only for a minute; we had to be on our way.

We headed out through the city and stopped at a service station close to the edge of town, where we discovered a clutch problem with one of the vans. Car repairs are typically done by the side of the road, by a guy with a couple of ramps, a few tools and a propane torch. They could have fixed it, but they didn’t have the right hose. No problem. Just squeeze everyone into two vans rather than three, and we’re on our way.

We stopped for lunch at a restaurant out in the middle of nowhere surrounded by a field full of pineapple plants. There was no sign out front, so I don’t know the name. We started with plates of foie gras (from ducks, not geese.) I tried some. Eh. Lisa chose to save room for some chicken fried rice. Much better.

It took another two hours to get to the Lutheran Hospital in Antsirabe. Lisa and I sat in the front of th van with the driver for this leg of the trip, and it was terrifying. We passed eighteen-wheel truck both ways on curvy roads barely big enough for two cars. We held on tight; the driver didn’t ven break a sweat. He’d driven this road dozens of times. He knew when to slow down for every pothole. The basic rule for driving here: no brake, lots of horn. We arrived safely and unloaded all our bags into the guest house, cleaned up and gathered in the common room for a supper of some very well done skinny chicken, rice, French fries and ziti. The prepared a ton of food for us. After supper, Dr. Harison took us on a tour of the hospital.

The hospital was rougher than anything I’ve seen for a while. The wards were filled with old beds, some without mattresses, and equipment. There were plenty of patients, many with family there to care for them. Lisa said that the hospital in Haiti was better than this one.

Lisa and I got to room together in the guest house. Our mattress was a simple piece of foam rubber that made you roll towards the center. Screens in the windows and relatively dry conditions made mosquito nets unnecessary. G’night.

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The first leg of our flight to Madagascar departed from Daytona Beach for Atlanta at 11:30 am Friday, October 9. We checked six large rolling duffle so of supplies and carried on all our own personal items. The duffle so weighed less than forty pounds each, much less than I expected. No line at the ticket counter and no line at security, so we had plenty of time to wait before boarding. Time for a little snack and some people watching. While I prefer to travel comfortably, some opt for tight skinny jeans, stiletto heels and revealing tops. To each his own.

We had a two hour layover in Atlanta, enough time to grab a Greek salad with chicken in the terminal E courtyard listening to a live alto sax player accompanied by his iPad. Sweet gig. A salad on the way out is pretty important since we probably won’t be eating many vegetables in Madagascar. Anything irrigated with or washed in the local water would be off limits for the next week.

Our next flight, from Atlanta to Paris, would take 8-1/2 hours aboard a full 767. We took off on time at 3:30 pm. The in-flight food of chicken or pasta was average. The complimentary wine was very good. I slept a little, did some reading, and watched the the second Hobbit movie, The Desolation of Smaug. Wifi on board? Though every advertisement said yes, the reality was no. I did catch a glimpse of the business class section, with its little pods where you could lay flat and sleep. Maybe someday.

We landed in Paris about 5:45 am and found ourselves in a mostly empty airport. We would eventual rendezvous with the other members of our team, but their flights didn’t begin arriving until 8 am. We walked to what we thought was our connecting gate, and then took a little shuttle to our actual connecting gate. A little coffee shop was open. We had some so-so coffee and croissant, and dozed a little in the gate area.

About 9 am, other people began showing up at the gate, including the members of our team:

• Pastor Jeff Kuddes, team leader from MO, who had been to Madagascar several times
• Diane, a nurse from Napa, CA
• Molly, a nurse from Iowa
• Tammi, Molly’s mom from Iowa
• Jane, a nurse practitioner from Wisconsin
• Samantha, a hopeful mad school student from Wisconsin
• Christie, a forensic science teacher from Glendale, AZ
• Jeanelle, a pharmacist fro Phoenix, AZ
• Peter and Donna fro Oregon. Donna is a nurse and Peter’s a pastor
• Lydia, a nurse from the Washington DC area

We all had a chance to chat while waiting to board the 777 to Madagascar. (Who knew so many people wanted to travel to Madagascar?) while chatting, we learned that the government had changed some laws, which might prevent some of our nurse practitioners from acting as providers in Madagascar. One rule of trips like this is that you must be flexible.

We departed at 11:30 am and the flight was uneventful. Flying with Delta (Atlanta to Paris) was much nicer than Air France (Paris to Madagascar). Upon reaching 10,000 ft, the flight attendants immediately brought out some iffy-looking food. Then they disappeared and we didn’t see them again until we we began our descent into Antananarivo, when they brought out some iffy-looking breakfast. I do not like them in a plane…I do not like them in the rain…I do not like green eggs and ham.

We touched down in Antananarivo, Madagascar about 11:30 am local time. We had been warned about the long wait at immigration, which indeed took about two hours. All of the three hundred passengers on the plane were funneled to a small glass cubicle containing eight government immigration workers. One took your passport, handed it to one of four people working at computers, who scanned your information and handed it to a third, who stamped it and handed it off to a fourth who signed it and called your name to pick it up. Not efficient, but it provided jobs for eight people.

The blessing of the night: all of our bags arrived with us. As you know, that’s a victory no matter where you are traveling. We loaded up in three vans and drove about 10 minutes to the hotel where we spent the night. It was easy to fall asleep at 2:30 am after about thirty hours of travel.

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