Like every mission to Ankavandra, the team had to be divided into two parts for the trip because of weight limits. The first team of five people left Tana for Tsiroanomandidy on Sunday 14 June in the afternoon, settled in Ampefy for the night, and on Monday morning we reached the Tsiroanomandidy airstrip, where MAF picked us up around 12:30pm. We arrived very late in Ampefy on Sunday (around 10pm) because the car had a radiator problem – fortunately, everything was eventually fixed.

The second team left Tana on Monday 15 June at 6:30am with MAF for a direct flight from Tana to Ankavandra.

On arrival in Ankavandra, we were greeted at the airport by many villagers, the town’s new mayor and his deputies, and by gendarmes, due to the security situation. As we arrived in the village quite late (around 3pm), there wasn’t time to make a formal courtesy visit that day, but the mayor and staff from the town hall came to visit us at the base. The following morning, we paid a courtesy visit to the head of the gendarmerie station.

Security
Ankavandra is still a bit dangerous. On the second day, there was a dahalo (bandit) attack in a small village 15km from Ankavandra; two people were killed. One person came to our surgical team to have bullets removed, and another arrived with a broken leg.

That night, we couldn’t sleep peacefully because there was an exchange of fire between soldiers and the local gendarmes, lasting nearly 30 minutes. It seems some of the soldiers had been drinking and provoked the gendarmes, who responded with warning shots. It was mainly a show of force on both sides. Sparks from the gunfire passed right above our base.

A great strength in Ankavandra is the collaboration between the local pastors and priests and the MMS team -especially our evangelists. They take turns leading a short religious service each morning before the day’s activities begin.

This time, the mayor took charge of organising the patients. He raised awareness and shared information effectively, and many people came – even from remote villages far from Ankavandra.

The town itself has improved a little – everything seemed tidier, especially the track leading to the airstrip. The mayor provided us with three carts to transport equipment and two plastic canoes to help us cross the Manambolo River.

We began our activities on Tuesday 16 June at 8am with a religious service led by the pastor of the Lutheran church, followed by a welcome speech from the mayor. We then shared essential information with patients about the services offered during the week.

Surgical cases were numerous, mostly hernias and appendicitis.

Story 1:
A 22-year-old woman had blocked fallopian tubes and a tumour on her left ovary. She had been trying to conceive for years without success and had no idea what was causing the problem until the ultrasound revealed it. Fortunately, the surgeon on this mission is also a gynaecologist and was experienced in treating this condition. He operated to remove the tumour and other affected tissue. He believes that, if all goes well, she may be able to have children as soon as next year.

Story 2:
Another surgical case involved a young man with a large tumour on his face. The operation was delicate because the tumour was close to an artery. Although the anaesthetist was initially hesitant, the surgery went well in the end.

During medical consultations, tuberculosis was still the most common illness in the village. We also saw many cases of high blood pressure, fungal infections, and especially bilharzia.

Tuesday 16 June was the official exam day in Madagascar. Two children fainted during their exams and were brought to us for care. They were admitted for a few hours to receive rehydration and treatment. The diagnosis was stomach pain caused by not eating breakfast. In rural areas, skipping breakfast is common as families often save rice for later in the day.

Story 3:
An ultrasound revealed a serious case of bilateral renal failure in a 26-year-old man. Both kidneys were filled with fluid and had lost their structure. In addition, there was a large tumour in his bladder. He could no longer urinate normally. The likely cause was untreated bilharzia. Despite the severity of his illness, he remained energetic and courageous. People in the bush seem incredibly resilient, even when facing life-threatening conditions.

One ongoing issue is the lack of lighting at the base. There is no lighting at all, and it is extremely dark at night – especially near the gate where the tents are pitched.

In general, the mission to Ankavandra went well despite the insecurity. The team is not discouraged from returning, especially since local security guards are often willing to protect the clinic. Many leave their official posts (sometimes without formal leave) and arrange for colleagues to cover for them so they can help safeguard the team.

Statistics – Total 522

Medical consultation 261; Ultrasound 140; Dental extraction 55; Surgery: major 18, minor 13. Ophthalmology 35.