Page 13 - QARANC Vol 15 No 1 2017

THE GAZETTE QARANC 11
as expected, there was a distinct lack of running water and electricity, we were made comfortable and very welcome.
The village medical centre was nothing more than three tin- roofed rooms run by the village Doctor and Nurse/Midwife. It was instantly apparent that the medical facilities were far more basic than we had anticipated; there was no running water, no personal protective equipment and no clinical waste or sharps disposal systems. Due to a lack of government funding and widespread corruption, the medical centre relied on little more than broad spectrum penicillin, anti-anthelmintics and donations of ‘plumpy-nut’ sachets from Unicef. Although it was clear that the medical staff did all they could to help the local people, the sheer lack of medical facilities meant that even basic care was virtually impossible.
During our time volunteering at the medical centre we were able to assist the Doctor with consultations. Diagnosis of disease and illness was frequently based on a brief medical history, blood pressure (using a manual BP meter from the 1920s) auxiliary temperature and occasionally a finger-prick antigen test. Diagnosis of malaria became a daily occurrence and it was normal to see children with severe chronic malnutrition. Frequently we would give mothers many sachets of ‘plumpy- nut’ intended for their child. However, it was obvious that it was utilised more as a ration pack for the entire family.
It was commonplace for people to have walked for hours, sometimes days, to reach the medical practice and we were shocked to discover that despite, the widespread poverty, Malagasy locals were still required to pay for their medical treatment. It was quite breathtaking to learn that a 3 day course of oral penicillin was costing 5,000 Malagasy Ariary. Although this equates to little more than £2, it is quite a
substantial sum when you consider that 76% of the Malagasy population live on less than $1 a day!
On multiple occasions the Doctor had to explain there was little we could do to help. An example of this was an elderly patient with AF and pedal oedema who was told in no uncertain terms she should return to her village to die. We were surprised by the direct manner in which the elderly patient was spoken to and equally by the understanding and co-operation of her family. It was immensely frustrating not to be able to give the patient the level of dignity and care she deserved but without access to diuretics and anti-arrhythmics there really was nothing else we could provide. Although it was frustrating at times to accept our lack of input, we had to respect local Malagasy culture and act only within the confines of the Madagascan healthcare system.
Our time volunteering in Madagascar was a unique and eye-opening experience of nursing within a rural environment where access to modern medical facilities is limited. Having had exposure to rural nursing practice, it has shown us how easy it can be to rely exclusively on modern practices, that are commonplace on the wards of the DMGs up and down the country. Upon reflection, our time in rural Mada has shown us that referring back to the basic principles of nursing practice is not at all a bad thing to do and perhaps, on occasion, we should all take a moment to appreciate the fantastic medical facilities we have at our disposal, both in the UK and on deployment overseas. We hope we will be able to take our experiences forward with us and utilise them later on in our careers as qualified Army Nurses.
Pte E Cox QARANC & Pte N Kirtley QARANC Department of Health Education, Birmingham
The Medical Centre against the Madagascan sunset