Madagascar 2018: 6 – 29 April

From 6th to 29th April we took part in the first health mission of the year in Madagascar; Dr Cristina Sciarra, pediatrician, Dr Viola Colombi, vascular surgeon, and myself took part. On the spot we availed ourselves of the help of Francine, a nurse from Antananarivo, whose collaboration was very valuable, especially to interface with the people we visited and hospitalized. In this period, moreover, we provided to start her theoretical-practical training as an operating room instrumentalist, with globally satisfactory results. This collaboration will be renewed at the next mission in Madagascar, whose departure is scheduled for the end of this year. day after our arrival we went to the village of Vatolatsaky, located about 130 km southeast of Toliara. The journey, between paved road and track, lasted about 3 hours. We have, on this occasion, reviewed all the patients in the village operated on last year (five), all extremely satisfied with the outcome of the operations. We also visited about 30 people, some of whom came to Toliara for more thorough checks or to undergo surgery. During the rest of the period we worked, as usual, at the Sain-Luc Clinic in Toliara, both with outpatient visits and with hospitalization of the most serious patients, as well as with surgery, 13 to be precise, some of which were also of considerable conceptual difficulty. Specifically, we operated on a girl with a forearm biosseous fracture, three patients with clubfoot, one patient with genu varum, one patient with a forefoot dislocation. We also amputated two infected toes of a foot to an alcoholic patient, who unfortunately will have to be subjected to amputation of the leg at the next mission. We also operated on a patient with stiff knee in extension for muscle fibrosis following a quinine puncture (Judet’s surgery), and corrected an inveterate dislocation of the hand and wrist to a 38-year-old patient by removing three wrist bones (the first carpal chain), extending the extensor tendons of the hand and covering the soft tissues by means of a rotation flap. For stabilization we used two metal wires (Kirschner wires).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Finally, I report the case of a 32-year-old woman, Florette, mother of eight children, who came to us in very serious respiratory failure due to a serious heart failure for which she had been prescribed drugs, which she has not taken in the last month because she did not have the money to buy them. Once hospitalized, in 4 days of therapy she lost about 16 liters of water, which accumulated in her body as a result of the untreated decompensation. An echocardiogram showed a serious cardiac pathology (dilated myocardiopathy with severe mitral valvulopathy), unfortunately on a congenital and not rheumatic basis, so it is not possible to undergo surgery. She is currently at home under pharmacological treatment, and goes to the hospital every week for check-ups.

published on May 7, 2018 

Piero Petricca