Mission to Madagascar: 117 Surgeries, 12 Days, Countless Lives Changed

Article from Israel

For more than ten years Dr. Omri Emodi and Dr. Zach Sharoni from Rambam health care campus  have been taking part in special delegations  treating cleft lip and palate  in third world countries. In an interview to this issue, they speak about the delegation to Madagascar from which they recently returned, about the operations under the challenging field conditions and about the relations with the other medical teams. 

Ethiopia, Vietnam and India – these are just part of the many destinations visited in the past 12 years by Dr. Emodi, Vice Chair of the Oral and Maxillofacial Department at the Rambam hospital and Dr. Zach Sharoni, Senior Doctor at the Plastic Surgery Department at the hospital, in the framework of the Operation Smile organization that deals with craniofacial problem of cleft lip and palate in third world countries. They recently returned from another mission in distant Madagascar, with its population of almost 30 million but merely 10 doctors on the island skilled in carrying out such operations.

“Cleft lip and palate  defects  occur when the lip or palate are not complete, in part or in total. This affects eating, speech and of course appearance.” Dr. Emodi explains.

He states that, unlike in Israel, where parents sometimes decide to cease pregnancy because of birth defect, in third world countries the situation is different and therefore the birth defect is very common. Moreover, in Israel the surgery is performed amongst children who are 3 months old and afterwards at the age of one year another operation is performed to repair the palate for those who need it. In Third World countries, on the other hand, due to the lack of experience and the small number of surgeons, many residents have to wait many years in order to receive medical treatment.

"The oldest female patient we treated in the delegation was 57 years old; she was unable to receive treatment till now. At such an old age the operations are more difficult and in general the cleft is more dramatic. These are life changing figures for us" says the doctor.

This is the third time the two come to Madagascar and Dr. Sharoni mentions that according to the number of cases it is likely they will return once more. They carried out 117 operations in 12 days.

"In the end what convinced me to join the delegation is the previous one and that is always the case. In each delegation we examine many children, usually twice the amount we can operate on, either because of the time available or for other medical reasons that prevent us from operating and we say “no” to many people and they have to wait for the next time. In Madagascar alone there are thousands of patients waiting.”

Sterility is a Relative Matter

Operation Smile is an American organization already operating for 40 years in over 40 countries. To date over 200 thousand surgeries have been performed to treat the defect. Usually, each delegation has a team of 50 members from various countries all over the world – pediatricians, surgeons, anesthesiologists and nurses -all of them volunteers dedicated to the important task. This time the delegation settled down in Antsirabe, the third largest city in Madagascar, at a traveling distance of 6 hours from the capital Anteneribo.

“These are 12-14 very intensive days. If in Israel we perform one or two such surgeries a day, here we are talking about 4 -6 a day. We operate on adults with local anesthesia only, just so we will be able to perform more surgeries" Dr. Emodi states.

As those volunteering in third world countries for many years, the two are quite experienced in working under difficult field conditions, however, this time the challenge was even greater. 

“The conditions were difficult -if in Israel we perform surgery in one room on one patient, here we operated on 3 patients in one room. This means 3 teams of at least 4-5 people. In addition, we worked with partial lighting, i.e head lighting instead of operating room lighting” says the doctor.

The experienced surgeons arriving from all over the world are joined by local doctors.

"The connection with the local team in Madagascar is more special than with the doctors all over the world. It is true friendship; we help them with medical equipment as well. But we also correspond and provide advice after our return to Israel, and among the delegations. We feel at home with them. We already know them very well and they love us” says Dr Sharoni.

During the two intensive weeks the team also tried to train additional local surgeons. To somewhat improve the population’s access to medical treatment.

“In the recent mission we trained another female surgeon who can now start to operate. Their surgeons join the delegation, the veteran experts, and we provide some kind of opinion about them. Those who pass successfully perform surgery by themselves afterwards” he explains.

When they arrived in Madagascar Dr Emodi was in for a surprise when the organization and the local team chose him as the leader of the surgical team.

“It was very exciting and surprising. I had no idea till then. A short while after we arrived at the island someone from the delegation came to congratulate me" he says.

The delegation also consisted of medical teams from countries not particularly considered fans of Israel, s.a Sweden, Norway, the United Arab Emirates and South Africa.    

At the end of the grueling days of surgery it is difficult for the doctors not to feel excited about the enormous significance.

“It is impossible to describe in words the satisfaction of surgery that merely takes an hour and a half and totally changes the life of a child and its family. It really is a good feeling for both sides” says Dr. Sharoni.

"The residents of Madagascar are actually quite introverted, but their reactions are very positive and make us very happy” Dr. Emodi adds.