In 2024, as the Africa Mercy continued to offer direct medical services in Madagascar, Mercy Ships and NGO Operation Smile collaborated to train and mentor local health professionals in comprehensive cleft care
This year’s World Health Day theme, Healthy Beginnings, Hopeful Futures, highlights the urgent need to end preventable maternal and newborn deaths. Around 300,000 women die due to pregnancy and childbirth complications each year, while millions of babies are stillborn and two million die within their first month of life. The crisis is most severe in low-income countries, where access to safe surgery is often out of reach due to financial and systemic barriers.
For babies born with cleft lip and palate in these regions, the consequences can be life-threatening. Parents struggle to feed their infants successfully, leading to malnutrition and, in some cases, death. Cleft lip and palate is the most common facial birth defect, affecting one in 500-700 of all live births. (Plastic and Reconstructive Surgery, 2012).
In the countries where international charity Mercy Ships operates, surgical treatment for these conditions is often unattainable. Infants fortunate enough to receive surgery through the hospital ship charity often first join Mercy Ships’ Infant Feeding Program to gain the strength needed for life-changing treatment. Here, babies facing severe malnutrition receive the nutritional support they need to become strong enough for life-changing surgery. These interventions offer the opportunity for a healthy beginning and a hopeful future—aligning directly with the mission of World Health Day.
One of the Lucky Ones
In many ways, 22-year-old farmer Joseph was one of the lucky ones – but lack of access to safe surgical care had a massive impact on his life.
As he neared the end of a 12-hour walk towards the Africa Mercy®, docked in Madagascar’s port city of Toamasina, he was reminded of the many years of social isolation he had suffered due to his cleft lip.
“If I had friends, I wouldn’t have walked alone,” he said. “I feel alone all the time because people don’t want to be around me. I can’t even hire laborers to work on my farm.”
Joseph grew up with big dreams, but being born with a cleft lip became a significant obstacle. “I wanted to go to school and one day, become a politician…but I couldn’t realize my dream because of this condition,” he shared.
In 2016, while the Africa Mercy® was docked in Madagascar, Joseph’s aunt tried to persuade him to travel to the ship for free surgery. However, he was terrified of leaving his village for the first time. Years later, in 2024, Joseph bravely walked into the Africa Mercy’s operating room to reclaim his sense of belonging through healing when the ship returned to the island nation. His journey echoes the call of Healthy Beginnings, Hopeful Futures; breaking barriers to access life-changing medical care and allowing individuals to embrace a future full of possibility.
Revisiting a Calling To Serve
Dr. David Chong, an Australian reconstructive plastics surgeon who performed Joseph’s surgery, first came to Madagascar in 1996 as a young doctor on the Anastasis. “I remember being very moved emotionally the first day I walked onto the ship,” he recalled. “It birthed in me a desire to do more in global health.”
Over the years, Dr. Chong continued to volunteer with Mercy Ships and other NGOs in Madagascar, returning multiple times as his career progressed.
In 2024, he returned to Madagascar with Mercy Ships as an expert in cleft lip and palate repair surgery. He explained why adults like Joseph often live with unrepaired cleft lips for many years in the country: “Madagascar faces both widespread poverty and a transport system that leaves many communities isolated.”
The World Bank classifies Madagascar as a low-income country (LIC) with over 80% of the population living below the poverty line. This economic hardship limits access to healthcare, resulting in delayed treatments and poor health outcomes for many. Yet, the World Health Day mission is clear: everyone deserves access to essential health services, regardless of economic status.
Despite these systemic challenges, Dr. Chong emphasized the country’s untapped potential, particularly its dedicated medical workforce: “It has a poor health system but combined with extremely talented health professionals.”
Strengthening Healthcare for Future Generations
In 2024, as the Africa Mercy continued to offer direct medical services in Madagascar, Mercy Ships and NGO Operation Smile collaborated to train and mentor local health professionals in comprehensive cleft care. In collaboration with the Malagasy government and through Mercy Ships’ Education Training and Advocacy (ETA) program, Malagasy surgeons, anesthetists, nurses providing nutrition and speech therapy, and a dentist — volunteering in the country with Operation Smile — came on board for specialized training. Dr. Chong played a key role in leading this training initiative.
Surgeons With Servant Hearts
Seeing patients like Joseph on board the Africa Mercy did not surprise Malagasy Pediatric Surgeon and Professor Romain Raherison. His oldest cleft lip patient was a 66-year-old woman.
“We asked why she still wanted the surgery at her age, and she responded, ’For 66 years, I wanted to wear lipstick and makeup like all the women,'” recounted Professor Romain.
Since becoming a surgeon in 2008, Professor Romain has devoted his career to performing surgeries in Madagascar’s capital and remote parts of the country as a volunteer with NGOs like Operation Smile.
Yet, he remains acutely aware of the gaps in the system. “We don’t have enough Malagasy surgeons who really master cleft lip and palate surgery,” he said, highlighting one of the challenges confronting the healthcare system.
Professor Romain relocated with his family to Toamasina to set up pediatric surgery in a public hospital and teach at the faculty of medicine.
Building Comprehensive Cleft Care in Madagascar
The training also encompassed essential aspects of cleft care like nutrition, speech therapy, and dentistry. This holistic approach to strengthen Madagascar’s healthcare system exemplified what Dr. Chong described as diagonal development. “We’re looking after this patient well, but we’re [also] looking for a way to create long-term change,” he emphasized.
This mission is deeply personal for Pediatric Nurse and Nutritionist Nivoharilala Niry Rakotoarimanana, who was part of the training. She’s passionate about finding solutions to reduce malnutrition in Malagasy children, particularly children with cleft lip and palate.
While working alongside volunteer nutritionists aboard the Africa Mercy, Niry learned how to support patients with proper nutrition before and after surgery. “I really gained knowledge; not only theories, but we have been able to participate in work,” she said.
Another critical aspect of comprehensive cleft care is speech therapy. Surgery is only the beginning of recovery for cleft lip and palate patients; a speech therapist’s expertise is required to restore speech fully.
“In a place like Madagascar, there are no speech therapists,” said Dr. Chong. “So, how can you do comprehensive care in Madagascar if there are no speech therapists?”
The answer lies in training and empowering individuals like Alida Rasoamanantena, a university student studying language sciences and an aspiring speech therapist. On board the Africa Mercy, Alida found mentorship under Australian Volunteer Speech Therapist Christina Petherick, who guided her in advancing her skills in speech and language pathology.
Creating a Healthy and Hopeful Future
An obstetric fistula clinic in Madagascar brings hope and healing to Malagasy women who don’t have access to affordable care. Staffed by Malagasy health professionals trained years ago in partnership with Mercy Ships, it exemplifies the sustainable impact of collaborative efforts in healthcare and helps women who have suffered the impact of a prolonged obstructed labor without timely medical intervention.
“The only way that change really happens is through knowledge…empowering people and advocacy,” said Dr. Chong. “I think there’s no greater way of showing love.”
By empowering these individuals, Mercy Ships is helping to create long-term, sustainable change—making Healthy Beginnings, Hopeful Futures a reality in Madagascar.
