HPC Fellow: Mich Rakotomalala, Operation Smile, Madagascar

Mich Rakotomalala is a Hilton Prize Coalition Fellow with Operation Smile in Madagascar. Her fellowship consists of work as a program coordinator in charge of cleft lip and cleft palate international surgical missions and  trainings in Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS) for in-country volunteers. In this post, Mich provides a glimpse of the type of hazards faced by staff in the field that can impact their operations and the communities they serve.

Plague Hits Madagascar Before Operation Smile Medical Mission
by Mich Rakotomalala

Madagascar, my country, is a large island in the Indian Ocean located at the east coast of southern Africa. Due to the political and economic environment in August 2017, it was expected that a plague epidemic would spread at a catastrophic speed, and it would be difficult for the government to control the disease in the beginning. High rates of illiteracy and promiscuity within the population of the capital, Antananarivo, were major factors in the lack of awareness on the disease and the way it would spread.

In fact, the plague is a disease, an epidemic which does not belong to yesterday but is still found today, mostly in poor countries. As is the case in Madagascar, the plague is endemic to the central high plateau, manifesting every year as a seasonal upsurge during the rainy season. Between mid-August and April there is bubonic plague (transmitted by sting of a flea) and so-called pulmonary plague, which is the most serious, transmitted through contact with simple saliva from a distance of less than two meters. It is obvious to see why the disease would affect mainly the population of the big city of Madagascar. The plague outbreak that began in August 2017 killed 202 people, and 2,384 cases were reported all over the country. The Malagasy capital was the most affected, with more than 400 cases, as well as Tamatave on the east coast of the country.

As a program coordinator based in Antananarivo, I experienced how the August 2017 Plague affected Operation Smile Madagascar in many ways. We had scheduled our International Mission for November 2017 in Tamatave Hospital, but all of a sudden everything had to be postponed. CHU Analakininina (Tamatave Hospital), which was Operation Smile’s local mission site, admitted several patients and gave them the care they needed. A few doctors and nurses from the hospital became infected and were quarantined and given the same treatment as all patients. At this time, the Ministry Of Health issued a directive that everyone must wear a mouth cover once they go out of their homes. Schools were even closed for three weeks, and all big meetings and shows were canceled. By that point, people were scared to go out; children could not even play outside.

As you might not know, Operation Smile offers free surgery for cleft lip/palate patients. In Madagascar, we do annual registration by running an awareness campaign all over the country and calling patients on the phone. Due to the plague epidemic, the mission scheduled for November had to be postponed, and we needed to call the patients again to notify them of the change.

In the beginning of November our team went down to Tamatave and reached out to patients at the hospital who couldn’t be reached by phone and still thought the mission was happening. We had to explain to them that the mission was being postponed, and why. Many patients who live far from the big cities wouldn’t know what plague is exactly about. You can imagine their reaction to this news, how sad these parents were, when we informed them that their kid unfortunately wouldn’t get surgery this time, and that they would have to wait for the next mission in 2018.

We had to explain to them about the risk of exposing a patient or a team member to the plague, who could then infect the rest of the team. It was very difficult for them to understand the situation. “Can you promise us that my son will get surgery next year? We have been away from our village hoping that when we go back people will look at him differently,” said Rayan’s mother. The mother of Maimona, a girl born with a cleft lip, cried. “Oh my God, I am going back home with my kid not healed yet. People will keep judging us by saying the curse our family got is not gone yet.” These were the kinds of questions and reactions we heard from everyone, and we really took the time to counsel each parent present.

You should know that most of those patients come from a very rural area, from villages far from the city. Sometimes they have to walk for hours to reach their home, passing red dirt roads or crossing rivers. But it’s worth it. Patients with a cleft lip or palate here in Madagascar are always looked at differently—sometimes people who meet them on the road get really scared or think that it’s a curse on the family.

You can imagine the hope these families have in mind while going to the hospital, thinking that the time has finally come for their child to be healed. As I put myself in their shoes, I completely understand the feeling that they cannot wait for that moment when their kid comes out from the operating room with that very new smile, a moment that they will never forget. So many parents wait for years for that moment. Looking up, then closing her eyes with tears, Maimona’s mother continued to pray for her daughter’s life to change forever.

Surveillance and treatment of patients suspected of plague continued, then by end of November, the Malagasy authorities managed to put an end to the plague epidemic which was raging Madagascar.

Throughout this period of the plague, I did not do much, could not heal any plague patient, but my Hilton Prize Coalition fellowship with Operation Smile gave me the opportunity to counsel families, guiding them and sharing their feelings, which I believe was just as important. I cannot wait to see the new smile these children will get when the mission reinstates next April.

(All photos courtesy of Operation Smile)

About The Hilton Prize Coalition
The Hilton Prize Coalition is an independent alliance of the 22 winners of the Conrad N. Hilton Humanitarian Prize, working together to achieve collective impact. Through three signature programs—the Fellows Program, the Collaborative Models Program and the Storytelling Program—the Coalition leverages the resources, talents and expertise of each of its members to innovate and establish best practices that can be shared with the global NGO and donor communities. Working in more than 170 countries, the Coalition is governed by a board comprised of the leaders of the Prize-winning organizations led by an Executive Committee and a Secretariat, Global Impact.

To learn more about the Hilton Prize Coalition, visit prizecoalition.charity.org, or contact prizecoalition@charity.org. Follow the Hilton Prize Coalition on Twitter and LinkedIn, and “Like” us on Facebook.

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