6 March 2004

Dear Friends
THE HEAVENS OPENED As we write, the rain from a tropical cyclone (hurricane) pours down and we pity anyone who is sick and travelling to the hospital this afternoon. The country is on the alert - Mandritsara has been given a grade 3 warning - which is the worst grade, meaning that the cyclone is approaching us directly, and the eye of the cyclone may pass here during the night with severe wind and rain. So we are battening down the hatches. But that is not the biggest climatic event we are preparing for.

One day. "The sun will grow dark, the moon will no longer shine, the stars will fall from heaven, and the powers in space will be driven from their courses. Then the Son of Man will appear, coming in the clouds with great power and glory. He will send the angels out to the four corners of the earth to gather God's chosen people from one end of the world to the other" Mark 13:24-27

What a day that will be! What a privilege, and what a responsibility is ours, to make known the Good News of Jesus in this day of grace. Thank you for your prayers for us as we seek to do that among the many needy people around us. We arrived back in Mandritsara just in time for the New Year - and have felt ever since that we are still trying to catch up from 2003! Elita was the first major tropical cyclone of the year - and made two circuits around Madagascar during late January. The airstrip was waterlogged and no planes were able to land for 2 weeks. Claire Broad, a medical student from Oxford, spent a longer elective here than planned! Some roofs were blown off - including the roofs of several of our village clinics - but the damage wasnot as extensive as along the northwest coast. The rain was, however, a welcome arrival for the people generally, giving hopes of a good rice crop.

PAUL & JOAN STEINKULLER

In December, Paul and Joan made an urgent trip to the USA, as Joan needed medical treatment. She stayed there for chemotherapy, while Paul returned here in January to give some more training in eye surgery to Dr Hanitra. He left finally in early February and made a visit to Fianarantsoa, in southern Madagascar, where he had spent several years training eye surgeons. The government awarded him a medal of honour for his services to the country. We really miss them here, but the training Paul gave to Hanitra means that she can cope with most eye problems that arrive. She hopes to do 500 cataract operations in 2004. As you pray for the work here, we would like to encourage you with part of Paul's testimony concerning the year he spent with us: "We have lived in Kenya and Malawi for several years, and in Madagascar since July 1998. In addition I have also worked in mission and government hospitals in South Africa, Iran, Jamaica, and Peru. Other than HVM I believe I have worked in a total of 14 mission hospitals and 10 government hospitals in various countries. Certainly HVM stands out as being, far and away, the very best of the lot.
In saying that I have considered the following:

A. Among the Mission Hospitals - Spiritual Aspects:
1. The Christian commitment of the staff.
2. Making the spreading of the Gospel the number one focus and priority of all that the hospital does.
3. Ensuring that the entire staff, every single person, remains constantly
mindful of the real reason for the existence of the hospital.

B. Among all the Hospitals - Secular Aspects:
1. Quality of the professional medical staff.
2. Competency of
administrative and logistic support.
3. Adequacy of medical supplies.
4. Adequacy and consistency of the support infrastructure"

That is the past, and we praise the Lord for that. The present disappointments, that we mention below (in News in Brief), remind us of our dependence on the Lord. The future is yet to pray for!

DUTCH EVANGELICAL BROADCASTING ASSOCIATION

Last year we were contacted by the Dutch Evangelical Broadcasting Organisation (Metterdaad). They were looking for Christian relief projects to sponsor through their TV/radio broadcasts and wanted to know about HVM. We were very busy and asked them to look at our website. After visiting that they said they were interested in the construction of our maternity unit. They broadcast information about a project and invite listeners to send in contributions. In their leaflet they say "The most important requirement that Metterdaad makes is that the project should not only involve financial support, but also the spreading of the gospel, because the gospel is the most important gift we can give. We can say a hearty "Amen" to that!
Here is part of the information we sent them on the "Necessity and Urgency of the Project".
An article in the British Medical Journal 18 January 2003 reviewed the Caesarean section rates in 8 African countries, including Madagascar, during the 1990's. The article states that "there is suggestive evidence that a Caesarean section rate of 3.6% to 6.5% (median 5.4%) is needed to address obstetric complications in west Africa and that a rate of 2% is a minimum". The rate for rural Madagascar was 0.8% in 1992, falling to 0.3% in 1997. This is the lowest rate of the countries surveyed.
The report confirms our observation that maternity services in rural Madagascar are seriously inadequate. We do not currently have a midwife and we do not offer maternity care. However we are the referral centre for surgical patients, and since the next nearest centre is 200km away, we do have many patients brought to us with surgical complications of childbirth. Very frequently we have patients brought to us suffering the effects of poor or absent maternity care - cases of ruptured uterus, vesico-vaginal fistulae, postpartum infection etc. Patients are carried in from far away.
Two days before writing these lines, a lady was carried in with
obstructed labour. She had been carried for 3 days, walking though 10 rivers on the way. She had a twin pregnancy and had had premature labour. The mother's haemoglobin was around 50%, one of the babies was dead in the uterus, but the other was saved by Caesarean section. The day before writing these lines, another lady was brought in from a village, half a day away. She had been seen by our community health doctor a
few weeks previously and encouraged to deliver at the government hospital in Mandritsara because of the risk (9th pregnancy). Our doctor could not bring her into our hospital as we currently have no midwife and no routine maternity services. She did not listen to his advice but stayed in her village until she went into labour. When it was clear that the labour was
not proceeding, she was brought into the hospital. At Caesarean section it
was noted that her uterus was extremely thin and bruised and on the point
of rupturing. Fortunately she was delivered of a healthy baby and her own life was saved.
One of Metterdaad's strict requirements is an accountant's report for the
last 2 years. We are very grateful to Derek and Brenda Alcock from
Northampton, for agreeing to come and prepare this report. They have been our supporters for many years and have previously served short term in a Bible school in Pietermaritzburg, South Africa. They plan to come for 3 weeks at the end of this month. Please pray that this might all result in
us being able to build the maternity unit.

NEWS IN BRIEF:

We were sad when Dr Rabe did not return from annual leave at the beginning of January. His wife never really settled in Mandritsara. Please pray for them that he might find an opening in Antananarivo. His absence has made us extra busy.
A new doctor has just started this month. Dr Patrick has recently qualified here in Madagascar. He is originally from the south of the Island, but his parents work near Mandritsara as teachers. He is a committed Christian.
Hopes of sending Dr Adrien to a hospital in Nigeria to get further training in Vesico-vaginal fistula repair have not worked out so far. The logistics of getting a visa for Nigeria are very difficult! We would also ask you to pray for Adrien's financial support. A number of folk are currently supporting him and this is paying about half the cost of putting his two elder boys through the French Lycée in Antananarivo. He needs another £2000 per year for the next 3 years.
We have had some major disappointments since the beginning of the year. One of our administrative staff was dismissed after he confessed to adultery with 4 women. He had also helped one have an (illegal) abortion. He was a Sunday school teacher and seemed to us to be a solid Christian. He has since asked us to pray for him and appears to show signs of wanting to put his life right before God.
One of our maintenance workers was found to have stolen bicycle parts from the hospital. He has never shown any real interest in the gospel.
One of the teachers from the Good News School, who resigned last July, has taken HVM to court with the help of a lawyer cousin. We will fight the case, as we believe we are quite innocent of the charges he lays. He was the choir leader in the church. All these problems weigh heavily on us and we ask for your prayers
Church roof. The roofing is here and we are planning to hire a firm from Mahajanga to erect it after the rainy season, probably in June. We need another £3000 to cover the cost of this.
MSAADA, the Christian architect firm in Tana who did the plans for the
first two phases of the hospital, are doing plans for 3 new buildings for us. 1. A centre for the Community Health Department (we are hoping Tear Fund UK may fund this).
2. A guesthouse with housing also for the Blondeels. We will need to raise this money ourselves.
3. A school building for the Good News School. If we cannot find a funding organisation we will also have to raise this money ourselves.

Annie McColm, our lab technician from Australia, has postponed her furlough for one year so that she can stay until Debbie comes to take over.
But we still (urgently) need another extra person in the lab now as the workload has increased so much.
John and Mair Pugh (nurse tutor for the nursing training school) are back at their home in France. Please continue to pray about their support
Debbie Simpson (Lab Technician from N Ireland) is studying French in France. They, and Robert & Christine Blondeel from Belgium (to run guesthouse) all hope to
come to Madagascar later in the year.
Our two Swiss nurses, Rebekka and Susanne, leave at the end of March.
Hilde Vlaminckx (Belgian nurse) is no longer thinking of midwifery training in S Africa, but plans to come here this month to take over supervision of the inpatients.
Esther Kaempf (Switzerland) is studying Malagasy in Antsirabe and hopes to
come here in April to be our mission administrator.
Dorith Liniger (Swiss nurse) is still patiently trying to get the paperwork necessary for midwifery training in South Africa
(Mseleni/Manguzi). She is planning to make a visit to South Africa later this month to try to move things along.
There are other workers we still need - doctors, physiotherapist, dentist,
mechanic, carpenter, evangelist/Bible teacher.
Our family are all well in England. Rebecca and Chris in Cambridge will soon celebrate their first wedding anniversary. They are very involved in Eden Baptist Church. Ruth and Neil are doing well in Wimbledon and at the Balham church-plant. Neil is busy writing his book on the Christian's struggles and hopes to begin to return to work part-time soon. Rachel is enjoying her one-day a week off from nursing to attend the northern Cornhill Bible training course in Sheffield. At Cornerstone Evangelical Church in Nottingham she is involved with a Bible study group for Iranian women. Reuben has notified his firm that he plans to leave in the summer. He is
considering Bible school options, but plans first to spend a year as an apprentice at St Ebbe's church in Oxford
Our sincere thanks for your prayers and support.

David and Jane Mann

PS. It rained a lot in the night and our day staff had to wade through the flooded river to come to work. We had a very small congregation at the service here. The centre of the cyclone passed at lunchtime today - lots of wind, then an hour or so of calm (the eye), and now more wind (in the other direction) and lots of rain. One poor lady was carried in mid-morning from a village a couple of hours away with a retained placenta after a miscarriage. She and her team of porters were completely drenched and shivering badly!
We have brought some duty nurses in to stay the night in the hospital, as the river will be impassable this evening.

Gifts for the project should be sent to

Bryan Lumb,
41 Upper Tooting Park,
London SW17 7SN.
Tel: 020 8675 1192

Please make out cheques to "Friends of Mandritsara Trust" (F.O.M.T.) Gift Aid forms are available.
Change of address for prayer letter:
please contact
Peter Currie,
1 Abbott
House, Nightingale Lane, LONDON SW12 8NW

Website: www.mandritsara.org.uk

 

David & Jane Mann, Rebecca, Ruth, Rachel and Reuben with Africa Evangelical Fellowship in Madagascar