Dr. Andry: Only Orthopedic Surgeon in Tamatave

Quick glimpse into the reality of local care and the determination of Mercy Ships to leave lasting, sustainable impact:

Created by Nancy Predaina on 09 Jul, 2015
Madagascar, the fourth-largest island in the world, is home to over twenty-two million people. But there are only eight surgeons who specialize in orthopedics and traumatology. Most of them are located in the capital city, Antananarivo.
In the port city of Tamatave, where the Mercy Ships is docked, Dr. Randrianirina Andry is the only orthopedic surgeon. He says, “We need to train more people to become orthopedic surgeons. We especially need more adequate conditions and equipment for these types of surgery.”

The statistics verify his statement. It is estimated that over 15,000 adults and children are afflicted with neglected clubfoot, and nearly a thousand babies are born with clubfoot each year.* In addition, people suffer from other orthopedic deformities, such as bowed legs.

Driven by a passion for bringing hope and healing to those who would never otherwise receive treatment, Mercy Ships provided 55 free orthopedic surgeries and over 990 orthopedic therapy services during the 2014-2015 Madagascar Field Service.

But Mercy Ships also invested in the long-term future of Madagascar’s health infrastructure by providing healthcare education. The healthcare education projects impart knowledge and skills, while modeling and encouraging compassion and a professional work ethic. In addition to offering internationally recognized courses for groups and structured observation in the Africa Mercy hospital, Mercy Ships also provides one-on-one mentoring opportunities.

Mentoring projects offer targeted, in-depth clinical teaching for individuals. Dr. Andry participated in our surgeon mentoring program, and he built a strong bond with his mentor, Dr. Frank Haydon.

Dr. Frank says, “Anatomy transcends language. Pictures and X-rays are common in any language. Dr. Andry has been quite keen to come in and work. He’s anxious to learn more. He’s very skillful … great technique surgically … he has good hands. We’re lucky to have him. He also has to take calls in the community and has a ward full of patients that he has to see twice a day.”

For six weeks, Dr. Andry spent two to three days each week as an active participant in our Africa Mercy operating room team. He absorbed a lot of knowledge. He says, “The difference between the training I got before and this new one is about the practice. Before, the training was theoretical. The practicing time was short. It was a theoretical training. That is what I got before. But here, we don’t have too much theoretical training! The most important is practicing. For example, in the operating room, I learned something new and easy to practice, something I didn’t know before. It doesn’t require special tools or something expensive that we cannot have. It’s easy and useful. It’s a knowledge that we can use directly, and that makes this training really different.”

The knowledge he gained has transformed Dr. Andry’s day-to-day practice. “I thank Dr. Frank. He taught me a lot – especially in pediatric orthopedic surgery. Currently it is Dr. Frank’s technique that I always use for the surgical treatment of clubfoot and also the Ponseti method,” he added.

Furthermore, like every surgical mentoring participant, Dr. Andry completed the WHO Safe Surgical Checklist training. According to the World Health Organization (WHO), the risk of care-associated infection can be 20 times higher in developing countries than in developed countries. Charitable organization Lifebox has partnered with Mercy Ships to promote quality, safe care, using pulse oximetry. In low-resource settings, this simple checklist has resulted in a 47% decrease of surgical mortality, 36% reduction in major complications, and 50% reduction in infection rates.

Dr. Andry teaches orthopedics and anatomy as part of the Medical Faculty of Tamatave, and he is passionate about sharing the knowledge he has learned. Through dedicated doctors like Dr. Andry, Mercy Ships hopes to leave a legacy that will sustain and spread.

Dr. Andry says, “My message for Malagasy people … having Mercy Ships here in Madagascar is really important. They help us a lot, especially for healthcare. For doctors … it’s really important for us because we get new knowledge, new experiences. It’s important for all of us, and we thank them all. For sponsors … thank you very much because without you, all of this would be impossible. I hope that sponsoring will continue. For the crew … I hope that you will continue to volunteer.”

* http://blog.cbmuk.org.uk/category/clubfoot/

Story by Eunice Hiew
Edited by Nancy Predaina
Photos by Ruben Plomp, Josh Callow and Justine Forrest

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Madagascar, the fourth-largest island in the world, is home to over twenty-two million people, Dr. Randrianirina Andry is one of only eight surgeons specializing in orthopedics and traumatology.

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Mercy Ships invests in the long-term future of Madagascar’s health infrastructure by providing healthcare education. Dr. Andry, a participant in our surgeon mentoring program, worked with orthopedic surgeon Dr. Frank Haydon (USA) as his mentor.

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Dr. Frank Haydon says, Dr. Andry has been quite keen to come in and work. He’s anxious to learn more. He’s very skillful … great technique surgically … he has good hands. We’re lucky to have him. He also has to take calls in the community and has a ward full of patients that he has to see twice a day.”

Photo Credit Justine Forrest, As part of Mercy Ships Mentor program, Dr Frank and Dr Andry assess an orthopedic patient during secondary screening

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Dr. Haydon and Dr. Andry work together to assess an orthopedic patient at secondary screening.

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Dr. Andry says, “I thank Dr. Frank. He taught me a lot – especially in pediatric orthopedic surgery. Currently it is Dr. Frank’s technique that I always use for the surgical treatment of clubfoot and also the Ponseti method.”

Meet Zoeline

Screenings, Hope and Happy Endings

Successful surgeries and restoration of life occur when the need of the people meet the resources of Mercy Ships. That sounds simple enough…

But as I illustrated in my last post, even the MEETING of those two factors is not simple. Madagascar’s population is not easy to reach, and our port city is not actually the largest city of the country–it is just the only appropriate port for our ship to dock. As a result, our screenings do not take place only in the capital city or only in the port city. The screenings team this year performed screenings in advance in some of the more populated areas–including Antananarivo, the country’s capital. In addition, screenings are being conducted in more remote regions that can only *easily* be reached via MAF–transportation with Mission Aviation Fellowship–and then more travel by foot or local transportation.

I think it’s important to realize how much effort we “rich” foreigners put into reaching our potential patients. NOW imagine living below poverty level–with the obstacle of coming to US. This is the reality of the locals here. Stories I’ve heard include families that have sold their Zebu (variety of cow here) or rice fields just to afford transportation to reach us. With a spiritual twist, you might interpret that as an act of faith. For some, it may be, but for many these are acts of desperation. Our patients come despite the rumors, advice and opposition. They do not know what to expect of us, but they do know what they can expect from life–or imminent loss of life–if they stay away.

Before I go on, you must know that not every surgery we perform literally saves a life. Many are restoring quality of life: the ability to run, walk, see, attend school, work, and marry.

There are loads of stories I could tell that could tear out your heart, but I’ll start with a happy one.


 

Back on September 17th, my cabinmate, her bus-buddy and I decided to visit the Hope Center.  [The Hope Center was  originally a rundown building next to a nearby hospital. Our Advance Team over the summer was hard at work restoring and refurbishing the building into what is now called the Hope Center. This building acts as an intermediary place for patients to stay who have traveled from outside of town–before their surgery and as long as followup outpatient appointments are necessary. This year, the building also houses our dental clinic and the Obstetric Fistula clinic. We plan to have the OBF clinic staffed and fully functional with locally trained nurses by the time we leave.]

Anyways. We grabbed local transport via Pus-Pus (a man-powered-bicycle-carriage…thingy) for 1,000 ariary a piece (about 33 cents) and arrived at the Hope Center. We greeted patients and caregivers reclining outside as we walked toward the entrance, “salama”…”salama”…”salama”…

When we walked into the large lobby, we were filled with excitement knowing that these were our future patients! Then in a split second, we were the cool new kids. The three of us were immediately adopted by three young girls that seemed to “rule the roost” so to speak. They loved our sunglasses. They each took turns putting them on, making faces, and throwing up “peace signs” with their fingers. Then they showed us around their current “home.” They took us outside to the back of the building where we sat at a table under a tent to shade us white girls from the sun. Silje (Norwegian) and Emily (Australian) taught the girls the “cup song” and I bought their affection with chocolate. Truly though, we did not need to earn their acceptance. These three girls were immediately attached to us. My heart could have burst with love for them.


 

Their names are Zoeline, Roseline, and Angina.

[To all my nursing friends–I know you’re laughing at the third name. It is pronounced Angeena. Calm down.]

Roseline is Zoeline’s twin sister. In traditional Malagasy culture, twins are bad fortune–and they both would typically be placed in door of the cattle stable or out in a field. If they survived, then they were apparently goodluck. So either way…whether they were saved from the absurdity of superstition in the first place or spared in its execution…these girls are certainly lucky to be alive. Zoeline was burned (likely by spilled hot water or oil) on her right foot, and Angina was burned on her left foot. Roseline is just tagging along.

Zoeline and Angina have both suffered burns of their feet that have left their feet and toes in upturned and distorted positions. I didn’t know it at the time, but they were patients I would treat regularly on the dressings team in the coming weeks. I grew to love each patient, but Zoeline stole my heart…


 

I do not know much of her pre-Mercy Ships story, but I do know this: She must have come from a distance away in order to be staying at the Hope Center before surgery. Patients who live nearby come straight from home the morning before their surgery. So I know she must have attended a screening prior to our arrival and had been approved for a second screening in Tamatave (where we are docked).

Our reconstructive, plastic surgeon is a diligent, commited man of God and an avid cyclist. He had just completed a cross country cycle in the United States this summer. Days before leaving for Madagascar he was out having a casual cycle when he was thrown over his handlebars and fractured his clavicle (collar-bone). This delayed but did not completely obstruct his arrival, thank God! It did, however, mean that less plastics patients would fit into the surgery schedule for the duration of his time with us. Thank goodness, Zoeline was approved and scheduled for surgery in the first couple weeks of Plastic surgery. For those who were not able to be operated on, they will have to wait until Dr. Tertius returns in January.

Each child-patient must be accompanied by a caregiver. And for some reason, that caregiver was her uncle. I never did meet her parents. I am not even sure if they are a part of her life at all.

Throughout her stay with us, there are moments I hope I never forget:
How she eagerly greeted me when she saw my familiar face on the ship the night before her surgery.
How she trusted me, through tears, as I removed staples from her graft site.
How she sped down the hallway with her crutches, just happy to finally be out of bed. [For the sake of the skin grafts, we go to certain lengths to prevent/reduce friction and allow new skin cells to form and attach.]
How I prayed for one of her graft sites that was not healing well . How she laid still, with silent tears streaming down her face, as she bravely trusted me again to remove the large, long k-wire from her great toe. [Props to Molly for keeping her distracted and encouraging me!]
How tenderly she touched her foot to the ground when she was allowed to bear weight.
How she was always filled with laughs and giggles.
How joyous her face looked as she walked with only one crutch. How determined and focused she was when I found her out in the hall one evening doing her walking exercises with no crutches at all! How she learned enough English to say, “Hello. Bubbles?”
And how I am honored to have met her.

On Wednesday, November 11th…
Zoeline, Roseline, and their uncle walked down the gangway and left our little hospital ship. They will stay at the Hope Center until Zoeline no longer requires rehab appointments or dressing changes by our outpatients team. In no time at all, she will be running again. It’s a lot easier to “rule the roost” that way.

Meet Zoeline