National Lutheran News

Serving the Malagasy people

Global Health Ministries provides administrative health care support

“It was indeed an honor and privilege for me to be there to see what is being done, and what can be done, even if there are serious difficulties and challenges. Where there is a will, there is a way. It is a fantastic part of the Lord’s Kingdom,” wrote Jim Noss, former 32-year missionary to Cameroon, about his recent trip to Madagascar. Accompanying Noss on the trip was John Carrico, system director of supply chain operations at Fairview Health Services. Their trip was a part of the consultancy service of Global Health Administration Partners (GHAP), a program of Global Health Ministries (GHM).

The idea for GHAP came to Cindy Wilke, a health administration professional with a strategic planning focus, while attending GHM’s 2006 annual conference. She realized she knew several hospital administrators who could meet mission hospitals’ needs for administrative leadership.

Over the next few months, GHAP formed with the vision “to build a worldwide network of health administrators dedicated to creating, supporting, and maintaining sustainable faith-based health systems.” Wilke says, “All things happen through God and God opens that door.”

From right, pharmacy supervisor, Dr. Nirina; Jean Noël Voriandro, her assistant in charge of drugs; and GHAP's John Carrico look over the well-organized supplies in the stockroom of Ambohibao Hospital in Madagascar. Photos provided by GHM

Noss also advocates firm actions by Madagascar’s local churches in supporting their hospitals.

Noss and Carrico’s Madagascar trip was part of fulfilling GHAP’s mission by going “through the door” into Madagascar. It built upon work and relationships Noss began in 2009 when he, the Rev. Tim Iverson, GHM executive director, and Dr. Nesa Joseph, vice-president of the Deaconess Foundation in St. Louis, Missouri, went to Madagascar upon the invitation of the Malagasy Lutheran Church, Fiangonana Loterana Malagasy (FLM). During that visit, they performed a management and financial audit of the Sampan’Asa Loterana Momba’Ny Fahasalamana (SALFA) healthcare system.

SALFA was originally founded by medical missionaries Dr. Stanley and Kathy Quanbeck, who say they were “privileged to walk, side by side, listening to [the Malagasy people’s] problems, sharing their burdens.” Since then, SALFA has grown into nine hospitals and 40 rural clinics. The 2009 recommendations included changing SALFA’s CEO and bylaws as well as decreasing staff size — all amidst the global economic crisis.

A renewed beginnning

Noss and Carrico’s three-week trip in November and December 2012 included participation in the meeting of SALFA’s restructured board of directors. During the meeting, board members adopted GHAP’s recommendation to expand the makeup of the board to include expertise from the business world, government, and communities with experience addressing difficult decisions. SALFA rebuilt itself into a highly respected umbrella healthcare organization.

Mr. Rakotomala closing up an order ready for shipment in the stock room of the supply chain department, SALFA Depot in Antananarivo, Madagascar.

During their trip, Noss and Carrico also sought to strengthen SALFA’s administrative capacities for medical supply orders, inventory, and stock management, as well as development of manageable, secure systems. Due to unpaid debts, SALFA became unable to supply hospitals with medications. Therefore, hospitals began purchasing many of their medications from local suppliers, despite the drugs’ potential inferior quality.

GHM and the ELCA made essential financial investments to stabilize SALFA. With drug accounts settled, SALFA ordered medications from IDA in the Netherlands for shipment by sea crate. Noss and Carrico encouraged them to follow the recommended supply chain using airfreight for faster delivery, more immediate distribution, timely use of the medications, and, therefore, a quicker financial return on their investment. They also reviewed new information technology under development for SALFA, which is integral to the supply chain efficiency and improved, accurate collaboration.

Despite new technology, supply chain potential, improved finances, and the government’s high regard, SALFA faces enormous challenges as it seeks to meet the healthcare needs of the very economically poor Malagasy people in communities with little infrastructure. Frustrated, the Ejeda area FLM synod president expressed the need for additional GHM assistance.

Noss also advocates firm actions by Madagascar’s local churches in supporting their hospitals. While he was still there, the church received an additional offering — the morning’s fourth — which brought in $65 for the hospital.

As Carol Berg, former missionary in the Malagasy Lutheran Nursing School, says, “I am blessed by the witness of our faithful Christian colleagues who, despite the current political chaos, steadfastly serve others.”

Mary Simonson Clark is a freelance writer and the director of the Minneapolis Area Synod’s Malaria Initiative.

The medical challenges in Madagascar

As the end of their 2012 trip to Madagascar neared, Global Health Administration Partners (GHAP) consultants Jim Noss and John Carrico visited Ejeda Hospital. Ejeda is located in southern Madagascar, an area of extreme poverty, poor roads, and a “red zone” of conflict between cattle owners, cattle thieves, and the military.

The only physician at the Ejeda Hospital saved this mother and her baby by performing a C-section in December 2012.

SALFA has grown into nine hospitals and 40 rural clinics.

As Noss and Carrico walked through Ejeda Hospital, they saw numerous patients who received life-saving care. At least six of the patients were medically ready for discharge, but could not leave to return to their homes because they were unable to pay their bills. (Unlike in the U.S., hospital charges are for medical procedures and not days of hospitalization.)

This was particularly true for a mother and her twins who remained hospitalized for three weeks because they could not pay their emergency C-section bill. The husband and father also remained at Ejeda since family members must provide food for the patients. The twins’ grandfather planned to sell cattle to pay the bill, but cattle thieves got there first. Instead, he sold his only possession of value, the bicycle he used to take goods to market. The family still owed $175. Making the situation more tragic, remaining in the hospital exposed the infants to the many serious diseases of other patients.

Cases of patients with unpaid bills also included a child improving from cerebral malaria, while still caring for her brother, and a woman recovering from ectopic pregnancy surgery. Noss and Carrico felt they could not leave without intervening. They deposited funds with SALFA, providing Ejeda Hospital with credit for supply purchases and allowing the patients to return home. However, Malagasies, without means to pay, continue to come in need of urgent care.

Mary Simonson Clark

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