Devin S Harrison, pre-DDS

After our leisure day back in Mahajunga, we drove back towards Ankarafantsika to our campsite where we’d be staying and operating clinic for the last week. Our new home was tents on patches of sand, with pit toilets, bucket showers (or gravity showers…if there was still water), and lots of rice. The Malagasies were our full board on this last site. Rice three meals a day. Sometimes egg with breakfast, vegetables and rooters for lunch, and more so in the evening. Occasional meat included zebo, chicken, and tilapia. Frankly, this last week was the most enjoyable to me. We’d all settled in, I guess, but what really brought me joy was the lifestyle. There seems like nothing to worry about when you live in a tent and eat cheap, simple, yet delicious food. I felt at home more often than I do in the States. Clinic was more of the same, though we were in a less closed off shelter…the wind got the better of us at times.

There were other teams at this site, mainly wildlife research people. Some of them from the States and a few Malagasies. They’d help us when they were free, and at night we’d all enjoy a good meal, some good music, conversation, and of course quality Malagasy beverages. Since we had little artificial light besides flash lights, we’d get to bed at a decent hour after chatting and being so tired sleeping on the ground wasn’t uncomfortable at all.

We did a few surgical extractions at Ankarafantsika, one endodontic procedure (with help from our Nomad portable dental x-ray unit), and even had a hypoglycemic incident in which I helped. Nothing like real, on your feet training. Granted, I’ve been training for that since I can remember (did I mention I’m an Eagle Scout?).

This is me! Taken with a phosphor plate. I got lucky and got four third molars!

The updates on this site have been sporadic at times. At once there was a near one year hiatus. This has a lot to do with my response to what’s happening in school. At the time if I were to write it would be only bad things, and perhaps our of perspective. I’ve had this response recently, whereas my frustration and tolerance struggle and hence so do my updates [I have one more forthcoming in the Madagascar series]. People ask me how I’m doing. School is school. Outside of school, I don’t have much going on. One of the things I do to relax and exercise sanity is photography. You may have noticed my black and white film photography on this site. A camera is something I can carry to school and use during the day, and processing the images doesn’t require enough time that I have no time for studying (contrary to brewing beer…which can take an entire evening).

The following image was a highlight of school. We were doing a hands on exercise with Dr. Kucine, who I’ve mentioned before. It was a Friday and I’d get out early after my session. And since we took turns, I had the time to step back and capture this image.

A small glimpse into that which keeps me sane.

After our clinic work at Ankazomborona, we packed up and headed back towards Mahajunga for a relaxing night in a fancy hotel. On the way we stopped to see MAF’s newest school, Smithtown South; its first secondary school. Construction was still under way and it’d be a while before classes started, but we were told the locals were excited to finally have a secondary school. On the drive off the main road to the school, one of the vans got stuck and we all pitched in to push it free. Back in Mahajunga we had a long dinner across the street from our hotel, which I followed with a leisurely shower (did I mention we didn’t have hot water when staying in Ankarafantsika?), and a long night of sleep in the cool A/C. In the morning we had another leisurely meal and took the time to tour the market and town. This is the day most of us bought our silver Malagasy bracelets. We had lunch at a nice French/Malagasy restaurant, and spent more time recovering from the hard, long days in clinic.

Ankazomborona was more of the same for us as far as sterilizing instruments and general assisting. We fired up the generator a few times to do a few composite restorations, to charge batteries, and to try to take radiographs (blew the charger at one point!). As the site was within a town; there were more kids in the area that we made an attempt to keep busy. We taught them oral hygiene and played games like duck duck goose. A local boy came in a few days for lunch to make kebabs for those that eat red meat; many appreciated this. $0.10 per kebab! It was neat to work within the town limits, to get a feel for how some of the Malagasies live and what they fill their days with. Two young girls came and asked us to practice English with them. They wanted to have American friends and to eventually speak ‘American’.

After packing up and saying goodbye to our beloved Hotel Akbar, we drove out to our first clinic site at Berivotra to load up the supplies for the haul to our next site. The Malagasis here were invaluable in precariously stabilizing heavy bins atop our field cars / vans. We drove a few hours passing small towns and rice fields to our next site, Ankazomborona and worked to set up clinic. During our week working at Ankazomborona, we stayed within the Ankarafantsika National Park in a hut that had western toilets and running (cold) water. There was a snack shack named Jungle Shack where we had most of our breakfasts and dinners. Here was had lots of THB beer, rum coco, omelettes, crepes, and general good times. I must admit the French influence on cuisine was well appreciated.

On our last day in Berivotra, MAF founder Dr. David Krause offered us to opportunity to join him in the field during his paleontology work. He showed us his major dig sites where he and his teams had found many remnants of what has come to be known as Majungasaurus and Beelzebufo, to name just two. The team has really hit the jack pot over the years. It’s neat to be walking along in the tall grass, and see ancient bones scattered all around. I was able to do some sifting work with one of Krause’s lab technicians Joe Groenke and an anatomy / paleo student from the University in Madagascar. I have to admit that I was kiddy with excitement this whole time. I never imagined I’d be in the field sifting for ancient bones

We packed up the clinic early and loaded everything up for the move to our next clinic site. No matter how hard you work to pack things up in an organized manner, there will always be challenges…especially with 10+ people helping to load up. Cornelia, the MAF CEO, and her Malagasy sidekick Benjy were invaluable on these days, not to mention the whole Malagasy team.

Upon return to the hotel we were instructed to clean up and put on our civilian clothes. MAF had planned a nice dinner for us as a swank hotel out by the water, complete with a pool. The meal was great, as were the drinks and the live music. Afterwards, a hand full of us stuck around and jumped in the pool. It was surprisingly cold, but refreshing after a long day in the hot sun.

Below is a video of one of our Malagasy team members showing us how it’s done on the vocals during dinner.

Getting There

Our travels to Madagascar included a limo to JFK (thanks Dr. Wynn!) through London through Nairobi through Antananarivo to Mahajanga. Mahajanga is a larger port city on the eastern coast. We’d be staying in a hotel there for the first week. Having done an outreach in Uganda two years previous, I was surprised by the luxury of the hotel. Can you believe we had AC units in the rooms? Across from the hotel was the Madagascar dental school, and down the street was the water; nice views. Urban Madagascar was obviously better off than that which I had seen in Uganda. Take a look at the price of a cola: in Uganda it was approximately $0.10 USD and at least $1.00 USD in Madagascar.

Clinic

Each morning would we have breakfast in the hotel’s common room and then load into the vans to drive out about 45 minutes to the rural clinic in Berivotra. We used the existing school built by MAF as our clinic. There was also a teacher’s house, and down the road a bit the paleontology research station. Most of the first day was spent cleaning and setting up for the clinic; in the afternoon we saw a few patients. Here the third year students were asking for assistance from the doctors frequently. It was amazing to see their progress over the first few days. Everything rapidly sped up, and their competency grew quickly. Us first year sterilizers were stuck in the sun all day, but that’s better than inside a classroom with no windows!

Accommodations

Lunch during clinic days would be out of the van. Usually bread and toppings/spreads, and fruits. Not first class, but certainly nothing to complain about. After clinic we’d clean up and jump in the vans before sunset for the drive back to Mahajanga. We’d typically eat at a local restaurant. The cuisine has a heavy French influence; the eating was good. It was not difficult to find meatless options. Often after a THB (the beer of choice) or rum, we’d head back to the hotel for relaxation before sleep for an early rise the next morning and another long day of clinic.

This video shows part of our commute out to Berivotra from Mahajanga and a brief tour of the clinic. Towards the end you see Drs. Wynn and Willoughby contemplating radiographs taken with our portable Nomad radiograph system.

In removable prosthodontics we’re working our way through learning complete and partial denture setups. I’m still working through the complete dentures. It’s a frustrating thing to learn, but we’ll get there someday, right?

I realized that during my February to November 2011 hiatus, I failed to mark any note about our outreach mission to Madagascar. I’ve decided to add a series recounting that experience. Check back here each Sunday for the foreseeable future for a new installment.

Some History

The Madagascar Ankizy Fund was started by our anatomy instructor, Dr. David Krause when a paleontology team of his noticed children observing their work in Madagascar. He wondered why they weren’t in school; in fact there was no school for them to be in. So the team chipped in, quickly raising the $500 it would cost to pay a teacher’s salary for one year. From there, MAF has built numerous schools in rural areas of Madagascar. Dr. Krause’s relationship with the dental eventually led to the beginning of dental outreach missions to the areas served by MAF’s schools. Today there are five schools in use (with a fifth under construction) and dental missions nearly each year since 1999. ¹

Dental Outreach, 2011

Beginning the previous year, two first year students were offered a position on the outreach team as the primary instrument sterilizers and organizers, as well as general assistants. I was interested in the outreach since I first learned of it, but was unsure if I would apply. It was unclear as to whether students that participated during their first year would be allowed to return third year to partake in the clinical experience. As soon as we learned that we would be allowed to re-apply, I was convinced I had to go. After writing an essay and a short interview, I was lucky enough to be selected as one of two first years to assist the team of six third years, and two participating faculty.

This year Drs. Wynn and Willoughby would lead the team, with assistance from Dr. Krause and MAF CEO Cornelia Seiffert as well as a team of Malagasi natives who were serve as facilitators, drivers, and translators. Our trip would span three weeks following the end of our first year (third years would be missing clinic) and we’d visit three different locations to provide treatment.

Over the next few weeks I’ll offer some thoughts and imagery about our experiences. For now, here’s a photo to hold you over.