Unplanned, Extended Stay in Madagascar

A letter from Martha Sommers serving in the Democratic Republic of the Congo

February 2017

Dear friends and family.

Let me take you to early morning in the village of Anjabetongo, Madagascar, last week. I wake up as the presunrise light enters my tent. Part of me wishes to roll over on the thin camping mat that cushions my body from the cement floor of this rural classroom in which our tents are pitched. Yet I know from yesterday that the early morning is the best time to take a walk. The temperature is still cool. So, I fumble into my clothes. Trying not to disturb Dr. Lucie Solofonirina, who is my tent mate, and not to let too many flies in the tent, I do my best to quickly unzip the tent and climb out. My stiff body somewhat stumbles through the tent door, and Dr. Lucie does wake up. She smiles, wishes me a good morning, and rolls over to go back to sleep.

Baobobs at dawn

I do a few yoga stretches, then head on the footpath toward the fields and the baobob trees. The village Anjabetongo, meaning place of the wide-trunked trees, gets its name from these baobobs. Small animals make their homes in their hollow trunks, and this morning there are so many birds singing in their branches high above my head. I pray as I walk, thankful for Jesus’ example when he woke up even earlier. Mark 1:35: “Early in the morning, while it was still dark, Jesus got up and slipped out to a solitary place to pray.”

Soon the sun comes up, and it is hot. Young boys laughingly greet me as they herd their cattle, goats and sheep to the seasonal lake just next to the primary school on this otherwise dry plain. Time to head back. I follow the herds, stepping over the fresh droppings that attract so many flies. Yes, so many flies. God help me be thankful for all things, including flies. Where there are herds that supply protein for the local diet, there will also be flies.

Grass runway at Anjabetongo seen through the pilot’s window

Women with young children are headed in the same direction. The muddy lake is also used for bathing. I recognize a few women who join the path as we get closer to the school, who are coming to help prepare breakfast for me and the rest of the mission team of Fiana Be Dia Be (FDBD). We greet each other in appreciation. FDBD is an ecumenical group begun by Korean Presbyterian missionaries Dr. Jonathan and Hannah Lee. Their surgical outreach to areas without hospital services is coordinated by Dr. Ramahalison Fernand René Olivier, who is a member of the PC(USA)’s Madagascar church partner, the FJKM. The FJKM and FDBD are increasing their collaboration to serve the rural communities isolated from medical care. This week the medical trip is combined with the child development program. FDBD’s relationship with the communities surrounding Anjabetongo dates back 10 years. I am grateful for their invitation to fly out in a small Mission Aviation Fellowship plane to join in their work this week.

For this week, some of the cement-block classrooms are transformed into a surgical suite, clinic, hospital room, and dental suite. Dr. Lucie, the other first-timer besides myself, is a dentist who works for the ministry of health and in private practice in Antananarivo. She took vacation time this week to join the team and see how she could assist in this part of her country she had not yet visited. By the end of the week she had extracted more than 120 teeth, learned about the local plants from patients who brought her baobob seeds and tubers to plant at home, had me tasting and buying a local salt from a family of one of the patients, and was known as the very calm lady dentist. The last afternoon, as we joined the two-hour trip over washed-out sandy roads to give a report to the government’s medical head for the zone, we laughed at how we were both nervous at the start of the week and so thankful how we made new friends. The children did not miss their classrooms. There were outside children’s programs going on all week as part of the mission and always some curious children congregating at the open windows.

Martha with most of the FDBD medical team

I worked closest this week with Dr. Bruno Rabemanantsoa, as I was invited to mentor him, utilizing the principles of family medicine. He has been working since finishing medical school as the only doctor in Soalala. Dr. Bruno uses his vacation time to join FDBD trips, serving and increasing his skills to further benefit Soalala. Of course, I learned much from Dr. Bruno about language, culture, country protocols, and how to work things out locally. The Mikea people, numbering close to 1,500, live in the Mikea forest east of Anjabetongo. Their lifestyle of hunting, gathering, and digging for tubers for fluid when water is not available keeps them mainly healthy. The main recognized public health threat they face is tuberculosis. The designated government sites for laboratory testing, treatment and follow-up are far away from the security of the forest and do not interface easily with nomadic lifestyles. Dr. Bruno had wonderful dialogues with a Mikea chief when we traveled to the medical zone office with the government personnel to problem-solve how to break down these barriers. I was humbled when he stood up at dinner the last night, thanking me for participating in his further education.

Madagascar has increased its number of medical school graduates and realizes that new qualified doctors need further training to be able to effectively serve their mainly rural population, which is spread over La Grande Isle du Madagascar. Dr. Samison Luc Heré, president of Universite D’Antananarivo Faculte De Medecine, said Madagascar does not yet have training in Family Medicine, yet wishes to develop the training for this specialty whose graduates could serve these rural areas effectively. By his invitation, I am working with Dr. Olivat Rakoto Alson, who is in charge of Human Medicine at the medical school, to set up a conference introducing Family Medicine. We are collaborating and drawing on the experience and expertise of Dr. Randrianonivelo Josoa. After 12 years of working rurally Dr. Josoa became national health coordinator of FJKM’s health ministry. His present job includes supervising 36 rural dispensaries. In this role he is acutely aware how standardized postgraduate training would improve rural care.

I am enjoying my unplanned extended stay in Madagasar, and I am thankful for FJKM’s invitation to join them in participating in their health ministries, collaborating with their health partners within Madagasar, and introducing them to international partners I have previously worked with. Such a joy it is to work together, and I am thankful for the long-term partnership between the PC(USA) and the FJKM, which makes these opportunities possible.

My heart also wishes to return to Tshikaji, in the Democratic Republic of the Congo, from which I was evacuated in September 2016. There continues to be violence between a local militia, Kamwina Nsapu, and government soldiers. More than 100 people were killed in the last few days because of this conflict. This makes it not yet possible for me, who was brand-new to Tshikaji, to safely return. There are signs of hope. Nationally the agreement signed in January between the government and the opposition is holding. My colleagues who have worked there long-term have been able to return. I will keep you posted. In the meanwhile, I am thankful for the emails from my new friends in the DRC and for the opportunity to continue to review the written assignments and research projects of the Tshikaji Family Medicine residents, which are sent to me electronically.

Thank you all for how you walk with me on this journey. Your prayers, emotional support, and financial donations make it possible. If you have not already made a commitment to this work, please prayerfully consider joining with me and our partners in ministry in the Congo and in Madagascar and being part of God’s beautiful work in these countries. I will be back during the second half of 2017 to visit churches and take my every-10 years American Board of Family Medicine exam. It will be wonderful to see so many of you then.

Peace,

“Dr. Martha”