McMullin Madagascar Musings
McMullin Madagascar Musings
15 years of Volunteer Urology Service Development
by Dr Richard McMullin, Volunteer Urologist
In mid-2013, I received an unexpected phone call from Sue Chapman, who had been our Urology trainee in Ballarat way back in 1995. It was an invitation to join her on a medical aid mission in Madagascar in October. Like many doctors, I’d been attracted to the idea of medical aid, but had not made the first step. Sue had already made four visits, starting the program in 2009.
It’s hard to prepare for the shock of confrontation when you land in Antananarivo. The sweaty crowds, the bustle, the rattling taxicabs and cattle drawn carts, the pot-holed roads, the dilapidated French colonial buildings and the oppressive summer heat draw you into this poor but mesmerising country.
Our medical base is Toliara, a further hour by plane in the southwest of Madagascar. Flat, dusty and arid, it’s hard to imagine a harsher place to eke out a living, yet hundreds of thousands somehow do.
Here we confront sinewy elderly men with urinary catheters and hopeful eyes, many having walked for days from their villages in the countryside, accompanied by loyal wives, sons and daughters. Some have not passed urine for months or years, and ADFA provides their only chance for resuming normal life.
For the team to do this safely and efficiently, much preparation is needed. Sue Chapman explained the infrastructure needed for us to make a difference. Nothing can be taken for granted. We are grateful for Toliara to provide a clinic to see our patients, a room in which to operate and local personnel to translate for us and care for the patients, but everything else comes via ADFA. Even the operating table, the anaesthetic machine and diathermy are second-hand Australian gear.
Photo caption: Dr Richard McMullin, Volunteer Urologist
Volunteer Urology team with hospital and ADFA staff, Toliara, July 2024
Prostate operations may not seem the most glamorous or inspiring form of medical aid, but they exemplify the pragmatic nature of effective philanthropy. Mostly the clinical problem is easily identified, requires minimal preoperative work up, is effectively treated with one operation and does not need follow up. There is minimal access to sophisticated pathology and medical imaging and no time for follow up appointments, so we can’t diagnose and treat complex cancers or obstructed kidneys.
Dr Richard McMullin & Dr Melvyn Kuan, Toliara, July 2024
Prostate operations may not seem the most glamorous or inspiring form of medical aid, but they exemplify the pragmatic nature of effective philanthropy. Mostly the clinical problem is easily identified, requires minimal preoperative work up, is effectively treated with one operation and does not need follow up. There is minimal access to sophisticated pathology and medical imaging and no time for follow up appointments, so we can’t diagnose and treat complex cancers or obstructed kidneys.
In the grand medical tradition of “see one, do one”, my next visit to Madagascar was without Sue Chapman but all by myself. Not wanting to let the team down, I ensured I was ready for next time, spending months gathering surgical equipment and the never-ending list of single-use items needed for prostate surgery, from syringes to catheters and antiseptics to antibiotics. This was to be the pattern each year, and I also needed to gather a team. Thus, over the years, a whole cohort of medical professionals from Ballarat swelled the ranks of ADFA including at least 8 doctors and 6 nurses. Before long we had recruited Lydia Johns Putra and two of the three annual urology missions to Madagascar originated from Ballarat.
In my early visits I mentioned in passing that I did a little paediatric surgery and was almost at once inundated with small boys with hernias. Thus, I began such operations but soon found the numbers and complexity beyond my capacity. How lucky was I to meet Berni Troncoso, a masterful and delightful paediatric urologist from Chile then completing a fellowship at the Royal Children’s Hospital in Melbourne. Berni now flies in from Santiago each year and has further recruited a Melbourne colleague to consolidate a dedicated paediatric program. Treating hernias satisfies the pragmatic principles of medical aid: the clinical diagnosis is straightforward, the treatment effective and the benefits enormous.
After nine visits to Madagascar, I’ve now retired, having benefited from fascinating medical and cultural experiences and having worked with wonderful people, both from the pool of fabulous ADFA volunteers and those beautiful Malagasy workers who make it possible on the ground.
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