Report 1

Reporter: Tom Peachey

Contact at destination:  Dr David Mann (surgeon at HVM), Dr NELY Jean Tsilizy (Directeur du CHRR de Diana)

Year of visit: 2010

Country: Madagascar

Institution: Hopitaly Vaovao Mahafaly (HVM) in Mandritsara and Centre Hospitalier de Référence Régionale (CHRR) in Diego Suarez

Departments: HVM: General surgery, obs and gynae, general medicine, community health.  CHRR:  pediatrics, general medicine and triage, urgences et accueil (TUA).

Work / Study undertaken:  At HVM I spent a lot of time in theatre assisting, and was supervised doing lots of spinals, intubations and sewing up after ops.  I went on ward rounds and led the occasional outpatient consultation with a nurse to translate.  I also went out with the community health team to help with vaccinations and see the difference that they are making in the very rural communities.  At CHRR I followed the ward rounds, went to outpatients clinic and hung around in TUA waiting for patients to arrive.  At both I was able to examine interesting patients with good signs, but taking histories was difficult as most patients did not speak French and staff weren’t keen or didn’t have the time to translate for me.

Description of the service and department:  HVM:  Busy but small Christian mission hospital serving a wide geographical area and 200,000 people.  Mixed local and foreign team working together with external funding which means that they are able to do a lot and provide a basic but good quality of care.  CHRR: A secondary care hospital with six doctors and a nursing/midwife school.  The staff are very knowledgable but held back by financial constraints.

Description of the destination:  Madagascar is unique.  It has aspects of African, French and Arab culture.  Madagascar felt quite cosmopolitan.  As an island the wildlife is very different from that found elsewhere (Lemurs, Baobabs) and Madagascar is a natural history hotspot.  In addition, it has beautiful white sandy beaches and unusual geography inland.  Mora mora (slowly slowly) is a phrase that is often heard, the pace of life is slow and people are very relaxed.  However they are also a lot of fun to be around, are very open, enjoy socialising and are keen to become friends.

Were the local people friendly?  Yes, very.  Even complete strangers would go out of their way to be helpful.  Friends even more so.  I would often strike up a conversation with locals.  More than a couple of times hospital staff invited me round for dinner.  Although some people might find the calls by people on the street of “Vahaza” off-putting, it is not meant threateningly.  I found learning the basics of Malagasy amused the locals immensely, and they would instantly take a liking to me if I asked them how they were in Malagasy before going on to have the rest of our conversation in French.  (Apparently the French aren’t so keen to learn the Malagasy language (!) – so locals were excited that I was taking at least a little interest in their native tongue).

Did you feel safe and if not why not? I felt very safe the whole time I was in Madagascar –  I’m sure there must be crime but I saw no evidence of it, apart from one evening when my bag was stolen from a restaurant – but nothing valuable was lost and I think that could happen anywhere. Although generally I was impressed by the skill of taxi drivers, especially on the awful roads, sometimes on taxi minibuses I wondered whether the driver had a death wish.

What did you do in your spare time? Is there anything that you would particularly recommend others to do? HVM: I had very little free time in at HVM, but with the little time I did have I spent with the other hospital staff who are all lovely: we watched films, went on walks, cooked food and generally hung out.  I read lots of books too.

CHRR:  I was less busy in this hospital so had a bit more time to explore the area.  In the evening there are lots of restaurants to get good food.  Seafood in Diego is delicious and cheap! If you buy a drink at the Melville restaurant in Diego you can use their pool for free!  It looks over the bay and is perfect for relaxing.  Ramena is a beautiful beach which is cheap and easy to get to from Diego (30min by taxi minibus), and they also have some other beautiful beaches that can only be reached by boat (I went in a fishing sailing boat which was quite an experience by itself – go down the steps to the left of the hospital entrance which will lead you to some fisherman’s houses and a little cove called Dordogne baie.  Ask someone to take you to the mer d’émeraude or trois baies, I went to the first and it was a paradise beach).  There are a couple of national parks nearby, which have bizarre scenary, lemurs and other amazing creatures!!  Apparently the Tsingy rouge are well worth seeing too, but I didn’t get there.

What time of the year were you there? What was the climate like?  March and April.  March was the end of the rainy season: hot, humid and lots of rain.  April was very pleasant, dry, clear blue skies all day every day, warm without being hot, and bearable nights.

What was your accommodation like?  I stayed at a guesthouse in Mandritsara which was cheap, very comfortable and spacious, and came with the occasional freshly baked bread included in the price!  There were other people staying there too who were great to get to know.  In Diego I stayed at the Pacifique Hotel immediately next to the hospital (it’s not in any guide book, but was cheap, clean, comfy and the staff friendly).

Was it provided? It was provided at Mandritsara, but not in Diego, although I found out whilst I was there that they can arrange accommodation if you would like them to.  The hospital accommodation in Diego was apparently in poor repair, so you’d be better off staying in a local guesthouse/cheap hotel anyway.

If not who arranged it?  Mandritsara was sorted for me before I arrived.  In Diego I waited until I got there and then found the cheapest clean hotel nearest to the hospital that I could.  It worked well as there were lots of places to choose from, all with rooms available because there weren’t too many people visiting Diego at that time.

How much did it cost?  Mandritsara £3.50/night, Diego £7/night.

Did you enjoy your visit? Yes, the whole experience was very worthwhile, people were extraordinarily friendly and helpful, and I learnt a lot too!

Did you find the visit useful medically? – in what way?  Yes, HVM allowed me to improve on and learn new practical skills, and increased my practical experience in surgery.  I was impressed by the difference community health programmes can have on health.  At both HVM and CHRR I saw a lot of clinical signs and interesting pathology that I would not see in the UK.

Has it improved your French?  Definitely, although this was mainly through having to talk to staff and work with clinical notes etc in French, as most patients did not speak French.

How has it increased your knowledge of French culture?  I haven’t really increased my knowledge of French culture per se, but I did gain an understanding of how the French had influenced this part of the world, and seeing which bits the Malagasy chose to retain was interesting (if frustrating – long lunch breaks were one thing the Malagasy seem to have kept with passion!)

If you went back would you do anything differently? Nope!  It was a perfect elective.

How did you get there? Kenya Airways via Nairobi.  There are also flights direct from Paris with Air France and Madagascar Air.

What was the approximate total cost?  £1300

Is there any other information that you think may be useful?  Buy a Malagasy sim card (and make sure your phone is unlocked first – I didn’t and had to buy a phone for £10 (which I sold at the end of the trip for £6!!)), it means people in the UK can ring on a cheap number (eg Planet Numbers) and it is free for you to receive the call.  Don’t expect to be able to use the internet – it did not exist in Mandritsara, was ridiculously slow in Diego and Dr Tsilizy is not contactable by email. The roads can be atrocious, especially during rainy season – my first journey was meant to take 19hrs, but took three days! It was so slow because we kept getting stuck in huge muddy puddles/small lakes which had decided to take over the road.


Report 2

Reporter: Jessica Harvey

Contact at destination: Docteur Andriamiarina Bruno, Directeur d’Etablissement.

Year of visit 2009

Country: Madagascar

Institution: Centre Hospitalier Universitaire D’Antananarivo, Joseph Ravoahangy Andrianavalona (JRA) and Befalatanana Maternity Hospital.

Departments : Pavilion St Fleur, Obstetrics and Gynaecology.

Work / Study undertaken:

We spent our mornings in the semi-private Pavilion St Fleur and our afternoons a stone’s throw away in the public Befalatanana Maternity Hospital.

In the Pavilion we attended the daily 8.00 combined obstetric and gynaecology ward rounds. We were closely supervised but encouraged to perform obstetric examinations. We observed and assisted in the natural births and in caesarean sections. We attended antenatal clinics where we helped with the maternal and fetal measurements. In addition we observed and helped wean the babies in special care.

In Befalatanana we were encouraged to record the partograms so we were more closely involved in manual fetal heart monitoring, fetal descent and cervicography. Occasionally we used ultrasound monitoring. I assisted in all stages of the deliveries; most memorably of a 1st twin after which I was encouraged to attend to the neonates. At other times this meant helping with the resuscitation of the neonate. I looked after a young lady who was suffering a miscarriage and observed manual evacuations of the uterus which is their practise soon after the birth or during spontaneous miscarriages. In addition I assisted with an episiotomy repair, my first real experience of suturing.

We had the freedom in both hospitals to visit other departments like neonatal care where in Befalatanna large, round cribs held up to 4 neonates. In addition I attended triage clinics.

Description of the service and department

The service at Pavilion St Fleur was comparable to my experience in England (Chesterfield Royal Infirmary) except these parents paid directly for the service. The Pavilion was also sponsored by Malta who appeared to subsidise the care. In contrast to the UK mothers were seen every month in neonatal clinic. They also stayed in hospital for around a week after delivery in which time they were encouraged daily, by both doctors and nurses, to breast feed. This was the most fascinating part which demonstrated the differences in our cultures. Male and female doctors alike would examine both breasts for signs of lactation by actively discharging them. The only thing stopping them perform this ritual, I saw, was a bad case of mastitis. However, the ladies rarely complained and I did not see a baby on bottled milk while I was there. This was seen as both unnatural and costly. Otherwise, the obstetric service was run by midwives overseen by consultants. Final years, in their case those in their 7th year, we expected to help operate. Teaching that we attended was in the on call room and included a drugs representative who handed out samples of antibiotics!

In Befalatanana, the overall structure was similar except the government paid for the service and had recently elected to pay for caesarean sections. This meant that indications other than emergencies were observed however the service was still fairly limited and breach births were managed by the mid-wives. The triage department was efficient in managing the need of care and if appropriate they were sent up to the delivery wards. This included those in labour, those in need of surgical terminations and those having miscarriages. There was no separation or privacy for the mothers except for the few that paid for the quieter ward. The hospital had an antenatal service in which classes were run and a special care baby unit. This was all overseen by two clinical directors.

Description of the destination

Both hospitals are near the central Lake Anosy of Antananarivo. It is possible to walk to most places of need and taxis are reasonable. The Lake is large and surrounded by the hills that make up the wider city. The hills have clusters of houses interspersed by church steeples and great flights of stone steps. The old town is behind Befalatanana and you can access the Rova (Queen’s Palace) through this.

Were the local people friendly? Did you feel safe and if not why not?

The people were remarkably friendly and kind. They were also willing to listen and adapt to our requests. For example splitting one bus ticket because I wanted to stop off and giving it to me for the same price. The women and children were particularly insistent when it came to asking for money. The men were generally respectful. I felt incredibly safe in both the city and the country. We were advised not to walk around the lake at night in particular. The one evening I got caught a bit short of light I was offered a lift in a 4 by 4 by a couple who had studied in America. On the whole I felt the citizens had so much integrity despite their trying political and economical situation. You hear some distressing stories but as long as you take the usual precautions you’d take at home you should be okay. ATM’s are also mostly guarded and off the street.

What did you do in your spare time? Is there anything that you would particularly recommend others to do?

In the city we highly recommend afternoon tea in Isoraka which is the ex-patriot area. There are a number of places and Hotel Colbert is a place to escape from the bustle if needed! We also enjoyed walking around the lake and even running around it. You could enjoy concerts near the president’s house which could be heard all around Isoraka.

We really enjoyed taking a taxi to the Queens palace in Ambohimanga outside Antananarivo. It is a beautiful place and worth the taxi ride for a good day trip. We bought a drink at the cafe by the road and drank looking out from their terrace to the paddy fields below.

What time of the year were you there? What was the climate like?

We were there in June and July. The city was warm during the day but cold at night. A number of days were cool and rainy. The coast however was hot as was the north. A perfect time of year enabling you to be active without risking dehydration.

What was your accommodation like?

Initially we stayed in a good hostel in Isoraka until we were given hospital accommodation on starting work. This was cleaned for us on arrival and had two single beds and an en suite.   It was basic but sufficient. The quad of rooms had a court yard with banana trees and a little pond.

Was it provided? The hospital accommodation was provided by the JRA hospital for free. In addition after few days they gave us breakfast and lunch from the hospital canteen gratuity.

Did you enjoy your visit?

Very much so. It is not your usual African experience, far from it. The culture is diverse, the city beautiful in its’ individual way and the people extremely generous in nature. There is so much variety in what to do and see and if you don’t mind travelling you can always find new experiences.

Did you find the visit useful medically? – in what way?

Yes, I was able to observe medicine in a developing country and this highlighted the differences in access to medical skill. In addition I was able to observe and take part in normal and complicated labour, examine the ladies and record keys findings. I assisted in caesarean sections and learnt about alternative ways to manage obstetric problems.

Has it improved your French?

Yes, the dialect was very easy to understand. If you take the opportunity to talk people are very willing to converse. We had some difficulties on ward round which were mostly taken in Malagasy but they would translate into French for us which provided a challenge I feel strengthened my hold on the language.

How has it increased your knowledge of French culture?

I have certainly increased by knowledge of French Patisserie and appreciation of their architecture but the Malagasy culture is very different. You can appreciate the influence.

If you went back would you do anything differently?

There is perhaps part of us that would have spent some time working in the Provinces to get a wider view of the island’s health needs.

I would also have informed my bank that I was in Madagascar – this caused some problems initially when trying to get money out!

How did you get there? Air Madagascar from Heathrow via Nairobi. Very easy and when we eventually found the transfer lounge in Nairobi airport we were sung to by a group of Japanese musicians!

What was the approximate total cost? £2000

Is there any other information that you think may be useful?

Learn a bit of Malagasy along the way, they really appreciate the effort you make. Make use of the Lonely Planet and Brady travel guides, the latter has some great reading! I found traveller’s cheques very useful and felt safer especially when you don’t want to be seen taking out too much money at the airport. When booking internal flights, call up the day or morning beforehand to check the times. They have a habit of changing them last minute and not letting you know! We were lucky because a friend had a Malagasy mobile number and he happened to be on the same internal flight as us so we were informed via him. Lastly, bring a pillow for taxi-bruisses!


Report 3

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).


Report 4

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 5

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 6

Reporters: Philip Doust, Christelle Evans and Elizabeth Yeates

Contact at destination: Dr David Mann,

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 7

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 8

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.