Mornings begin early here in Madagascar with the sunrise. I have been told that the Malagasy are naturally morning people. I assume they work during daylight hours because there is limited and sketchy electricity at night. I have to say that those staying in the guest house are definitely morning people, too. It's so beautiful outside, and that makes mornings a great part of the day. The hillsides are vibrant with color in the mornings! Thankfully the mornings also offer fresh pastries, scrambled eggs and devotions. A great way to begin the day.

Today we took a short drive, less than thirty minutes, to a town called Vinaninkarena. This village seemed to be a bit more wealthy than the previous villages where we have hosted Mercy Medical Team clinics. The houses are a bit more substantial than the shacks we have seen previously. We again set up our clinic inside the Malagasy Lutheran Church that is in the town. It is impressive how quickly we can turn a sanctuary into a makeshift medical clinic!

The same stations were set up again: intake, triage, meet a provider and pharmacy. Every patient receives a worm pill. It is common for individuals in Africa to have worms in their gut, which affects their nutrition status. Each village seems to offer a more common diagnosis or chief complaint that we treat that day. Today there were many people who needed to receive prescriptions or prescription refills for blood pressure medications. Dr. Harison and Domonia are starting to repeat villages where clinics have been held previously, so I think some patients return to receive more medications. Other patients are there to receive medications at no charge rather than paying at a local dispensary. Today we also cared for many patients with upper respiratory infections, and we saw a couple goiters that will need to be surgically repaired. In fact, Dr. Harison is going to use donated money from this trip to provide a much needed goiter surgery for one patient. The cost is only $300, but to a rural Malagasy person this is unaffordable. In previous clinics we have seen a child with severe hydrocephalus who cannot afford to have surgery. There have been many patients who have gone through who have seizure disorders. We have diagnosed several pregnancies that have already progressed quite far without the woman realizing she was pregnant.

Our clinic was quite successful again today. We were able to see 414 patients and fill 968 prescriptions between the hours of 9:00 AM and 3:30 PM. Impressive! Unfortunately, there were still another 100–150 patients who desired to be seen today. Time was not an issue for us, but we were starting to run out of vital medications. Dr. Harison wrote down the names of those who were still hoping to be seen, and he plans to return to the village at the end of the month to care for these patients. This is exceptionally generous of him! I believe he hopes to keep peace with the villages and try to please as many as possible.

Today I had the pleasure of using an African bathroom. Out in the villages, these are outhouses that are basically buildings built around holes in the ground. This is quite the experience. It goes right along with my mattress on my top bunk that has a sinkhole in the middle of it. It's all part of the African experience. And I just keep thinking that I still have it way better than most Africans, who deal with these and even worse conditions on a daily basis. I am grateful for the opportunities and lifestyle I am able to live, but I cannot believe the disparity between developed and developing countries. Basic amenities in the U.S. are unheard of here in Africa. And amazingly, the Malagasy seem to be happy and content. This is a lesson for everyone to learn from.

On the way home we stopped by a group home. This is a place where children with Down Syndrome and Autism are cared for and taught during the day. I believe Domonia has been doing outreach with this group home. We stopped by to deliver some toothbrushes and toothpaste as well as some candies and puzzles. One sweet girl there has been learning English, and she thanked us in very fluent English. This visit to the group home and to the Toby pull at your heart strings because these patient populations really have no resources in these villages.

This evening we went out into Antsirabe to go shopping again. We returned to the gem market and then went to this neat store where a lady makes her own paper and then decorates it with fresh flowers to make stationary, scrapbooks, and other items. The family also has caterpillars that they raise or keep for their silk in order to fashion silk scarves. It is interesting to see the loom and how the scarves are made. We all helped out this merchant!

When we returned to the guest house, Domonia's mother had displayed all of her embroidery work. She embroiders items such as tablecloths, table runners, napkins and wall hangings. It is such intricate work! The amazing part to me about shopping here in Madagascar is how little value the Ariary (Madagascar currency) has. The basic exchange rate, which varies by day, is $1 for 2300 Ariary. Many pairs of earrings made from precious stones were being sold for 20,000 Ariary, which is basically $9. Insane! The note cards—handmade, mind you—were selling for $4.50 for a pack of 8–10. A hand-embroidered tablecloth with twelve napkins was selling for about $38. It is heartbreaking to see that the hard work of the Malagasy people is worth so little financially.

Tonight we had another elegant meal at the guest house. Domonia plans out all of the meals and shares the recipes with the cooks who are hired to work at the guest house. Tonight we had pork ribs, mashed potatoes, couscous and chow mien noodles. Dessert was served in fancy parfait glasses again and was fresh papaya with scoops of vanilla and chocolate ice cream. We have been able to try the Three Horse Beer that is manufactured here in Malagasy. Many have described it by comparing it to an Odell's brew.

Tonight they hauled an old television down to the guest house and literally had one of the cooks stand outside and try to hold an antenna to bring in a television signal for the purpose of watching the news. The news station from Antananarivo came down today to film the clinic and to create a news story that was aired tonight on the news station. We were able to see the picture with a bit of snow fuzz on the screen, but we were unable to hear the sound. It was neat to see the story, though, and hopefully this will spread the news about what the LCMS is doing here in Madagascar.

The evening again concluded with sorting and repacking medications and preparing for another day of clinic tomorrow. Thankfully our team has found our groove and is working efficiently and effectively. I'll be curious to see how many patients we see tomorrow!

“Hesed” is a Hebrew word that means “kindness”, “mercy”, “loyalty”, “loving-kindness” or “steadfastness.” It’s the way God intends us to live together—a “love your neighbor as yourself”, active, selfless, sacrificial, caring-for-one-another brand of living contradictory to our fallen natures. The “Heseders” are continually looking to work together to share some small measure of God’s extraordinary love. Won’t you join us?