I met Bao Zoma, mother of four and grandmother of seven, while taking a bike ride through the countryside of Madagascar. In September 2015, I joined Bao Zoma as she traveled to the Operation Smile medical mission in Tana with her middle grandchild, Sandra, who was in need of a cleft lip repair. Now that Sandra has a beautiful smile, Bao Zoma is motivated to find more children in need of critical surgical care and bring them to Operation Smile. She has become a spokesperson for Operation Smile in the part of her country where radios do not reach and many cannot read the posters that are taped up at the health huts around the village.
When asked what motivates her to find more children suffering from cleft lip and cleft palate, she responded: “My grandchild once suffered from cleft lip. My grandchild Sandra was teased, dropped out of school, and was a shy girl. Now I can’t keep her in the house, she has many friends, and is constantly smiling. She is beautiful. I would like to give that gift, the gift of smiling to others like Sandra.”
Bao Zoma recently recruited two other patients for the upcoming medical mission here in Madagascar in April.
She walked eight kilometers, crossed a river and hiked another two kilometers to reach these children– a young boy by the name of Gino and a young girl named Nordine. I am happy to report they will be joining me on the medical mission in April.
Thank you Bao Zoma, not only for serving as a spokesperson for Operation Smile, but also for being an amazing grandmother.
Check out my story on Operation Smile’s Blog: A grandmother’s wish
Where I buy my fish….
At the far point of town, the water from the Canal meets the salt water from the Ocean. Every morning loads of small canoes paddle heavily through the huge waves to go out for the catch of the day. Being the fish eater and lover I am, I go out to this point to buy my fish. It has become a small ritual that I have come to love.
-How are you? How is your health?
-I am great. Here to buy fish.
-You love fish!
-Yes, it’s good for your health.
-Yes, MY fish is good for your health!
-Yes you are right 🙂
My conversations have become rituals, things that I have come to love and admire about this place I call home. This pictures are some of the regular children and women I meet on my morning fish purchases.
Let me start by explaining a bit as to why I am passionate about Operation Smile’s mission. Operation Smile changes lives. I have witnessed multiple cleft lip babies pass away due to malnourshiment and starvation. Babies do not breast feed, mothers stop producing milk, and the culture of wet moms is not prominent or practiced often here on the East Coast. This leads to parents trying to find solutions on how to keep their child alive.
Last year I biked over 80 km to find children or adults suffering from cleft lip and cleft palate. I stumbled upon a young mother who was holding a tiny fragile baby. The baby cried and couldn’t produce tears do to how malnourished he was. I told her about the program and she agreed to meet me on the day of departure. ON the day we were supposed to meet to go up to the capital city, she never showed up. I worried, called the contact number I had with no luck. I continued with the mission and brought up 7 patients. Upon my return I biked back out to her village. Once there I spoke to the village chief of the village I found the small cleft lip baby. The mother greeted me silently and said, “My baby died two days before I was supposed to meet you”. I am not sure if we could have operated on this child, seeing that it was in such a state but I promised myself that I would try even harder to find all the cleft lip and cleft palate patients I could and bring them up to the Operation Smile missions.
Why do individuals not go for sugery? (seeing that the majority of the patients this year are older)
I think this is a great question. I can only speak for the conversations with the people I have had here. The majority are scared. The majority have not heard of Operation Smile because they live in the countryside, do not have phones, and do not have radios (electricity has also been limited to two to three hours a day in some villages). The majority of people tell me that they are scared because they believe that to fix cleft lip you take skin from your thigh and paste it on the mouth then sow it together. Not sure who this tall tale happened. Many do nt have the funds or money or strength to walk from their village all the way to a village where there is a direct brousse to Tana or Tamatave.
How am I finding them:
I start with flyers, and stories, personal stories. I have previous Op Smile attendees come with me to remote villages and vouch for all the great work Op Smile does for its patients. These “promoters” become the back bone of my search, they are my ears and eyes. Since they have been on the mission with me and we have a relationship they promote their story.
This year I used the churches, evidently you know that Madagascar has more churches then they know what to do with. I used the churches to get the message out to a wider radius. People trust churches therefore they trust the program the churches recommend, meaning they trust me. Trust is the glue to getting people to accept coming on the mission, sometimes when I talk to cleft lip patients and their families I feel like I am begging them to come, to trust me. Wee must consider Malagasy people have long standing assumptions and stories about foreigners. These stories definitely put a wrench in my search.
After the churches I talk to the chef fokotany, the chiefs of the villages. I explain to them the details of the program and they become my spokesperson.
Lastly I bike. I bike and I walk to every village I can carrying around 50-60 flyers handing them out. Some people just stare, some people in fear and others in amazement because of the fact I am speaking Malagasy. But in all they listen. That’s the most important. Sometimes I sit and have coffee with them, talk some more and slowly but surely one person mentions, “ oh yea in that village over there, you know by the red building across from the church theres a cleft lip child.” So I walk over and indeed there is that beautiful smile I am looking for.
I am an education volunteer so I use my students to get the word out as well. They have been great helpers in getting indivudals to trust me and not steer away at the sight of a foreigner.
“Malaria is a dream stealer!”
Second day attending the Senegal Malaria Boot Camp. After two days of traveling, meeting 33 Peace Corps volunteers serving all over Africa, Bootcamp has begun!
Today has been extremely informational and educational. This afternoon, we had the opportunity to skype Dr. David Sullivan from Johns Hopkins University. His focus has been on infectious diseases and in particular a large focus on Malaria.
We began the discussion by defining “what is malaria?”
My fellow PCV ‘s answered with academic responses such as ” Malaria is a parasite driven disease with two vectors….”
Dr. David responded, “yes, but in reality Malaria is a dream stealer!”
He is right, malaria has been stealing dreams from children in sub-Saharan Africa for decades and continues at a rapid pace. Last year alone 1 million deaths mainly affecting children under 5 and pregnant women were caused by malaria.
Some background on Malaria in Africa:
There are 5 strains of malaria, the most common and lethal one being P. Falciparum. When considering Madagascar the entire island is at risk, with hot spots being the east coast due to the seasonal rain showers and humidity.
Symptoms of Malaria are :
Within these African countries there are several different diagnosis methods.
The first and gold standard being microscopic testing, with blood smear. This allows you to know quantitatively how much parasite or infection density parasite per micro liter is in that person.
The difficulty of microscopy are that it is time consuming ( 15-20 ) mins, requires trained experts to administer and use the equipment, and of requires the equipment.
The next diagnosis method and what I believe to be a huge innovation are RDT’s ( rapid diagnostic tests ). These tests come in small packages. The plastic test has a small location to place the blood droplet after you have pricked the patient and a small space for the buffer liquid to be placed. In ten minutes the results can be seen.
The advantages are that the RDT’s are sensitive, fast, simple to perform. Most importantly require no electricity.
The disadvantage is that the RDT’s do not test for P. Vivax a strain of malaria common in Tanzania and parts of East Africa.
Some fun statistics, “In 2012, 200 million RDT’s were given out most being given to Africa!”
On a community or village level, I have personally seen the benefits of using the RDT’s and the quick results being produced. Of course like everything there is not a 100% efficacy rate, there may be false negatives or damaged tests.
While speaking with Dr. David he brought up an interesting graph showing the effect that heat has on RDT’s. Imagine for a moment a box of 300 RDT’s coming to my village on the East Coast of Madagascar. The tests have travelled days even weeks, spending maybe hours in hot humid weather. The graph showed that hot weather reduces the efficacy of the tests. Therefore it is important to keep in mind that there may be some false negatives.
The larger issue in wanting to eliminate malaria in African countries is that individuals can be asymptomatic. These asymptomatic individuals can still transmit the disease.
I think to myself, well an active approach to this problem is to test all who have cyclical fevers or are showing signs or malaria. The problem is that asymptomatic individuals show absolutely no symptoms… What to do then?
The treatment for malaria is ACT. It is an artemisinin based drug which dissolved the heme killing the parasite. There are different drugs who treat malaria stage specific illness. Ex: liver stage, red blood cell stage.
I have found a backlash from my community in taking ACT due to the fact that the second day of taking the three pill treatment, the patient feels very weak. In Mahanoro people have steered away from taking the treatment to malaria because of the controversy behind the feeling and bodily reaction when taking the pills.
This year I need to focus on working with my Community Health Workers, to educate the community about the importance of taking this drug.
I am looking forward to doing more research and learning more about what is on the horizon for Malaria Initiatives and inventions in the future. I have heard of talks of:
-a vaccine against malaria arising
-lasers killing mosquitoes carrying P.falciparum ( look it up so cool!)
-and using saliva and urine for diagnosis instead of blood samples
Things are looking up. Malaria has received much attention in the news and researchers are working hard.
This is Landrycia.
A couple months ago her grandmother reached out to me having heard that I brought children to an Operation Smile mission in Tana. I greeted her and her grandchild and explained that I would not be able to attend the mission held in Tamatave yet if she was prepared to travel on her own I would ensure that she would make it safely and be housed. I coordinated with the Catholic Church in Tamatave and paid this woman and her grandchildren fare up to the city.
Two months passed by and no sign of her or her grandchild. With no cell phone it was impossible to reach out to her. I didn’t know if she made it safe. I didn’t know whether her grandchild had been a candidate for surgery ( suffering from cleft lip).
At 8 months she looked tiny, thin, weak, and tired. Her mother had a difficult time breast feeding her because of the cleft lip and had been ostracized by members of her village for not properly caring for her child, thus leaving the child in the care of the grandmother.
Today, a young girl ( the one in the photograph showed up at my house. I responded “Akory!” (Hello!”) my mind turned she looked familiar. Then a few seconds later her grandmother came around the corner, “charlotteeyy! Efa sitrana Landrycia!” The grandmother yelled ” she is healed!” I stared in awe. This young girl was no longer weak, no longer thin, no longer without hope. She stood in front of me with beautiful big round eyes, healthy as can be barely a scar in sight.
Thank you Operation Smile.