Madagascar Project Introduction
Madagascar was a French colony from the late 1800's until 1960, when it became an independent country. Most of the country's 13 million population survive through subsistence farming, cattle raising, or fishing. With a Gross National Product (GNP) of US$ 210 per capita, the World Bank has consistently rated Madagascar among the ten poorest countries in world.
There are two medical schools in Madagascar - one in Antananarivo and one in Mahajunga. Together, they graduate 250 physicians each year. There is no shortage of physicians, but there is a lack of supplies, equipment and other support services. The University of Antananarivo sponsors postgraduate training programs in Internal Medicine, Pediatrics, Surgery, Gynecology, Pulmonary Medicine and Anesthesia.
There were five facilities licensed to provide histopathology services. The two medical schools provide diagnostic pathology services but it was unclear how current their services were. The Military hospital has pathology services but this was limited to military patients. There were two private laboratories in Antananarivo that provides histopathology services but their charges ($10 per case) were not affordable for most patients. Most of the Malagasy patients, therefore, have been treated without the benefit of any pathologic diagnosis.
SALFA - Sampan'asa Loterana Momba Ny Fahasalamana is the Health Department of the Malagasy Lutheran Church, dedicated to serve the healthcare needs of the people of Madagascar since 1978. With its headquarters in the capital city of Antananarivo, SALFA operates twenty-four healthcare facilities in Madagascar, including ten hospitals.
Pathologists Overseas’ Involvement - This project formally took shape in February 1998, when Heinz and Alice Hoenecke visited the SALFA headquarters in Antananarivo. Discussion with SALFA officials led to the formation of a plan to provide histopathology services to the people of Madagascar and to train selected Malagasy physicians in the field of Pathology. A proposal was submitted to the United State Agency for International Development (USAID) for financial support and a three-year grant was subsequently awarded.
A histopathology laboratory was established in the headquarters of SALFA in Antananarivo and we accepted the first specimen in January 1999. Three trainees were recruited - two from the SALFA medical staff and one recommended by the Ministry of Health. The necessary reagents and supplies were purchased in the United States and shipped via SALFA's United States affiliate - SALFA-USA. Most of these direct expenses were paid out of the USAID grant.
Some of our volunteers come from academic institutions and many other volunteers have teaching experiences as well. We devised a structured training curriculum for our trainees with periodic quizzes and tests to provide objective evaluation. The two trainees from SALFA completed three to four years of on-the-job training and are now responsible for the service work of this laboratory.
Project Finances - Most direct expenses incurred by SALFA or Pathologists Overseas were reimbursed by USIAD through the grant. Cash donations from project participants supplemented expenses that were not covered by the grant. In-kind donations from project participants accounted for the remaining contributions.
Current Status - In 2003, the SALFA AnaPath laboratory received official accreditation as a histopathology laboratory. The diagnostic services are now rendered by the two Malagasy pathologists that we trained - Drs. Rakouth and Lalao. The specimen volume is still lower than we have anticipated but has remained stable over the years. Our project director, Dr. Frank Kiel, returns each year to oversea the services and we have recruited a few volunteers to visit as well.
