Rehabilitation of a cardio-pediatric care unit in Madagascar, in 2021

Since 2018, in Madagascar, La Chaîne de l'Espoir has been implementing a program to support the development of pediatric cardiac surgery, which represents the only alternative for survival for many children suffering from heart disease. Today, to offer them the possibility of being treated at home, La Chaîne de l'Espoir is financing and supervising the rehabilitation of the cardio-pediatric care unit at the Centre hospitalier de Soavinandriana (CENHOSOA), in Tananarive.

With an average annual per capita income of €439, living conditions on the island of Madagascar are precarious. In 2020, the country of over 27 million inhabitants ranked 162nd out of 189 in terms of the human development index. A complex situation in which the young population is paying a heavy price. One child in two suffers from malnutrition and/or stunted growth. Health care provision remains limited.

“ The right to health is a constant battle for Malagasy people and their children. ” Dr. Nivo, Malagasy specialist in pediatric cardiology and coordinator at La Chaîne de l’Espoir.

At present, the lack of human, technical and financial resources prevents the treatment of several types of pathology. This is particularly true of certain pediatric heart diseases. In Madagascar, over 3,600 children are born with heart defects every year. Unfortunately, the remoteness of health establishments and families’ lack of financial resources prevent many cases from being detected. And even once a diagnosis has been made, it is sometimes impossible for sick children to be cared for at home… To be treated, they have to leave.

A young girl at the Children's Pavilion in Kabul

A dream: open-heart surgery for children in Tananarive
So, since 2018, to offer these children an alternative and a chance of survival, La Chaîne de l’Espoir has been implementing a program to support the development of pediatric heart surgery in Madagascar. Since its inception, this program has enabled:

47 children to undergo closed-heart surgery
Evacuate 64 children to France (mainland France or Reunion Island) for open-heart surgery
Enable 1,366 children to benefit from a cardiology consultation
Train 26 general practitioners on the telltale signs of heart disease

Rehabilitating, training and caring for Madagascar’s children
To reduce the mortality rate among children suffering from congenital or acquired heart disease in Madagascar, La Chaîne de l’Espoir is running a 3-pronged program:

Training Madagascan medical staff
Since 2019, a transfer of skills has been taking place during medical-surgical missions organized on the island. On these occasions, the volunteer team from La Chaîne de l’Espoir in La Réunion (located 1h20 by plane from Madagascar) comes to reinforce the Madagascan team in carrying out closed-heart operations on children. To further prepare local medical staff for open-heart surgery, the Madagascans should also soon benefit from training courses or visits from specialists.

Care for young Madagascans suffering from heart disease
Ultimately, the program aims to improve the entire care process. From screening to follow-up, including planning operations for sick children at the Soavinandriana Hospital. Finally, if necessary, for cases deemed too complex, La Chaîne de l’Espoir will also help organize evacuations.

Rehabilitation and equipping of the CENHOSOA cardio-pediatric care unit in Tananarive.

Rehabilitation of the cardio-pediatric care unit at the Soavinandriana Hospital Centre

The current renovation of CENHOSOA’s cardio-pediatric care unit is the cornerstone of the project in Madagascar. Financed by La Chaîne de l’Espoir, work began in the first half of 2020, thanks to the skills of Bouygues Bâtiment International, in charge of the project, and numerous other local and international partners.

On completion of the project, the unit will comprise :

An operating theatre dedicated to cardiology and paediatric cardiac surgery
4 wake-up beds
A nursing station
Sterilization
Support services
Technical rooms

An operating theatre and premises equipped with :

Operating table
Electric scalpel
Ultrasound
Extracorporeal circulation (ECC)
Mobile Scialytic
Patient heater
Autoclave
Scrubber
…

Thanks to this initiative, open-heart surgery will soon be possible in Tananarive. In 2022, the plan is to carry out a minimum of 2 to 3 medical-surgical missions every 2 months. These missions will last 8 to 10 days, during which one to three children will be operated on each day. For local doctors, the increased frequency of these missions will also be an opportunity to benefit from a more in-depth transfer of knowledge from their Reunionese colleagues.

Although additional technical resources and skills have been allocated to Madagascar for pediatric cardiac surgery, there is still room for improvement. What’s more, the financial resources needed to treat all children suffering from heart disease are still inadequate. Indeed, the cost of open-heart surgery on the island is estimated at €4,500. A sum that many families cannot afford. This is why La Chaîne de l’Espoir will continue its support. Firstly, through the continuation of numerous missions, and secondly, through financial aid, which will notably enable the medical evacuation of children suffering from complex cases.