The journey to our second of 20 hospitals in Madagascar turned out to be quite an adventure! The long and winding road that leads to Ambatondrazaka is an 827km round trip from the Africa Mercy in Taomasina, and gets some pretty heavy use from large trucks carrying timber, rice, and other goods. So many thanks to our team co-ordinator Ali who negotiated 12 hours of road like the one below to get us to our destination! When the rain stopped however the view was truly beautiful.

On our arrival we were joined by a local translator named Leah, who often works with the local Peace Corps. The team at Ambatondrazaka are very busy, serving as a regional referral centre and trauma unit for a very large region, so it was fantastic to have 24 people from their team join us over the 3 days to develop their own local version of the WHO Checklist for use in their operating theatres.

Simulation sessions in the operating room allowed all the members of the team to get used to using this safety checklist tool, and many commented in the course feedback how they enjoyed seeing the effect of using this system on team spirit, encouraging open and effective communication, helping to keep the patient safe by dealing with potential problems before they arise.

It was my privilege to deliver a teaching session on monitoring and managing oxygen levels during surgery in my slowly improving French, with help from Leah to translate into Malagasy! As Bear Grylls loves to remind us in his survival programs, you can only survive around 3 minutes without oxygen, so the new Lifebox pulse-oximeters we brought with us enable the team to detect and manage falling oxygen levels much earlier during the dangerous time during and immediately after surgery when problems with oxygen delivery are frequent and potentially fatal. These units really are little ‘boxes of life!’

The anaesthetic team including a doctor and 3 anaesthetic nurse practitioners immediately put the teaching to use in the afternoon with managing a simulated hypoxic episode in the middle of surgery using the treatment algorithm for falling oxygen levels.

As with all the hospitals we are delivering training in, we plan to follow up in a few months and see how this team is doing, so it is very exciting to see the passion and commitment of these Malagasy colleagues to develop their teams and give the best possible care to their patients.

After a short break on the ship, the Checklist team will head out to our next hospital for our biggest course yet, I won’t be back to the Ship before December so will get used to living out of a suitcase for the next 2 months!

I almost forgot the pyramids… Rice is a several-times-a-day feature of the gastronomic experience here, but this presentation in Ambatondrazaka was a spectacular first!