Until infrastructure improves, MAF/HoverAid bridges health gap (credit: A.Randrianasolo)

On 11 December 2024, the African Development Bank approved a $165 million loan to improve access to trade, healthcare and education across Madagascar. As the country looks forward to new and improved bridges, roads and ports, MAF’s Antsatiana Gino Randrianasolo looks back on MAF’s critical 25-year partnership with HoverAid, which has been bridging the healthcare gap.

Madagascar’s new multimillion-dollar infrastructure project aims to improve regional and national connectivity and strengthen trade corridors to mainland Africa.

Development includes upgrading the 48 mile stretch of road between Bevoay (south-east) and Morombe (south-west) and reconstructing the 460 metre bridge over Manombo River (south-west).

Investment will also improve trade between Tuléar Port (south-west Madagascar) and Beira Port (Mozambique).

Villages like Sahakevo don’t have any access to healthcare (credit: A.Randrianasolo)

A solid partnership enables access to healthcare

As the people of Madagascar await their new infrastructure and roads to connect them to basic services, thousands of people living in the wetlands still have no access healthcare.

For nearly 25 years, MAF has partnered with HoverAid who run mobile medical clinics so that isolated, rural Madagascan communities have access to health services.

MAF engineer Tim Longley (R) developed HoverAid’s 1st hovercraft (credit: Stuart King)

It was MAF’s Tim Longley – an aircraft engineer and designer – who founded HoverAid in 1969. He developed the ‘River Rover’ hovercraft initially for Lake Chad, which straddles Chad, Nigeria, Niger and Cameroon.

Tim’s ‘River Rover’ was originally meant for Lake Chad (credit: MAF Archive)

Today, MAF regularly flies Madagascan and international volunteer doctors from the capital Antananarivo out to remote airstrips. From there, HoverAid uses hovercraft to transport medics into the wetlands to treat people in desperate need of medical attention.

Around 350 patients per week are treated during a mobile medical clinic enabled by MAF (source: HoverAid). Clinics include consultations, surgery, scans and dental work.

MAF/Hovercraft mobile clinics incl. minor & major surgery (credit: A.Randrianasolo)

Bendalana’s story

During September’s mobile medical clinic, MAF and the HoverAid team meet Bendalana. The 53-year-old father of seven from remote Ankavandra Village in western Madagascar was shot by armed robbers who stole his cattle. Bendalana takes up the story:

‘It was a typical evening. I was outside my house, checking on my two cows when suddenly, thieves came. In the chaos, I tried to flee. I thought I would die.’

Bendalana was shot in the back by cattle thieves (credit: A.Gino Randrianasolo)

Bendalana was shot in the back. He collapsed and the world went dark. His attackers stole his cows and left him to die. Sadly, cattle raiding is the source of much insecurity across the region. The sound of gunfire at night is common.

Although he was rushed to the nearest basic health centre where they managed to stabilise him, Bendalana needed more advanced treatment for the twelve shotgun pellets lodged in his body.

His nearest hospital in Tsiroanomandidy, central Madagascar, is a two-day return trip by road – an expensive and harrowing journey.

In a bid to reach hospital, Bendalana drained his family’s finances to endure an endless pothole-ridden journey via truck. Each agonising jolt was made worse by the unrelenting scorching sun, which often reaches 40 degrees.

Bendalana wondered if he would survive the journey.

An x-ray reveals bullets & fragments in Bendalana’s body (credit: A.Gino Randrianasolo)

The hospital x-ray displayed a number of bullets deeply embedded in his body. After returning home, although stabilised, Bendalana felt sick whenever he tried to eat:

‘I think it was because of the multiple bullets that made their way from my back to my belly.’

Isolated but not forgotten

Without his cows and too incapacitated to support his large family, life became very hard for Bendalana. He was worried about his health and with no money coming in and seriously depleted finances, the future looked bleak.

Fortunately for Bendalana, the MAF / HoverAid partnership offered a glimmer of hope in the darkness.

Despite flight, medics wade through water to reach Ankavandra (credit: SR. Solberg)

When MAF flies HoverAid doctors from Antananarivo to Ankavandra Airstrip, it only takes 50 minutes by air. This is followed by an hour’s hike through rough terrain and crossing a river to reach Bendalana’s village.

Without the plane, overland it would take the team around four days to reach Ankavandra Village.

Team behind Bendalana’s op. incl. surgeon Tata (head torch) (credit: A. Randrianasolo)

The team do surgery in Ankavandra’s basic health centre (credit: A.Gino Randrianasolo)

After assessing Bendalana, surgeon Tata Jean Floris removes one of the bullets from his body. Tata explains:

‘Some of the bullets are very hard to spot since they are quite small, so I recommend leaving these small fragments in place initially as they aren’t causing any immediate harm. Removing them surgically might cause more damage than leaving them in for the body to deal with naturally.’

The body will eventually expel bullets making it easier to operate (credit: A. Randrianasolo)

Tata reassures Bendalana that he will be fine and that the remaining fragments are in soft tissue and close to the skin, meaning that the body will eventually reject them so that a surgeon can extract them more easily at a later date.

Bendalana breathes a sigh of relief:

‘I am looking forward to the next mission in our village. The doctor coming here is priceless for us.’

Bendalana – beneficiary of the Hovercraft / MAF mobile medical clinic

For Bendalana and Ankavandra Village, the sight of a MAF plane means regardless of their isolation, they are not forgotten.

Olivier’s story

Olivier is a volunteer anaesthesiologist with HoverAid (credit: A.Gino Randrianasolo)

During May’s mobile medical clinic in Sahakevo Village, eastern Madagascar, anaesthesiologist Olivier Rakotomampianina and the team were having dinner after a long day, when there was an urgent knock on the door.

Sarah* was about to give birth, but due to her medical history including two miscarriages, a caesarean section was the only hope for a safe delivery.

The team quickly gathered their equipment and a generator to provide light for the operation.

Sarah* & baby survive caesarean in bush thanks to team (credit: A.Gino Randrianasolo)

The team’s quick response saved the lives of both Sarah and her baby. Without them, the pair may not have survived the birth.

MAF flew the HoverAid team from Antananarivo to Sahakevo Airstrip. Although MAF saved them a three-day road trip, they still had to continue on foot and by river with villagers helping them to carry their lifesaving equipment.

Despite flying, the team still continue on foot to reach Sahakevo (credit: A. Randrianasolo)

Olivier – who has completed more than 15 mobile medical clinics – understands the huge role MAF plays in reaching isolated communities:

‘Flying makes a big difference – especially when it is far.’

Olivier Rakotomampianina, HoverAid anaesthesiologist & MAF passenger

Without advanced hospital equipment, Olivier relies on an oxygen extractor in the bush, which pulls oxygen from the air. In turn, HoverAid’s surgeons rely on Olivier’s precise calculations and vigilance, which ensures the patient feels no pain during surgery.

Given a patient’s condition could rapidly change within15 seconds, Olivier meticulously monitors their blood pressure, oxygen levels, and other vital signs to ensure stability.

Anaesthesiologist Olivier hard at work (credit: A.Gino Randrianasolo)

As the people of Madagascar wait patiently for their infrastructure to improve, MAF continues to enable HoverAid’s medical volunteers like Olivier to bridge Madagascar’s health divide – transforming and saving thousands of lives in the process.

Rural communities wait months to access healthcare (credit: A.Gino Randrianasolo)

*Sarah not her real name