During medical school I was introduced to the idea of serving overseas, having become a Christian in the summer before university. I served on two CMF summer teams in Central Asia, and felt God place on my heart the desire to serve him overseas in the longer term. I found my Foundation years hard, and after FY2 decided that it was the right time to take a break and explore what serving overseas might look like.
I had remained in touch with the rural mission hospital in Mandritsara, Madagascar, where I had spent my elective. I returned there to serve for a three-year period, spending most of my time at the 50-bed hospital, with particular responsibility for paediatrics, but working across all areas of medicine.
All staff are Christian and the gospel is preached freely, to a population with mainly animistic beliefs. It was so refreshing to start the day praying with colleagues, and to be able to share my hope in Jesus with my patients. It is part of the on-call doctor's job to preach an evangelistic message on the wards in the evening! I learned to rely less on investigations and more on clinical diagnosis, as well as managing uncertainty, and using older medications that I was less familiar with. In the UK, there is always something more to do, someone else that can help, and as a result I often forget to pray and ask God for help. In Madagascar, where patients were so sick, and resources scarce, I rapidly reached my limits and needed to pray - and was then able to testify to my patients of God's faithfulness and of answered prayer.
I'm often asked questions like these:
How did you decide to go?
Pray, pray, pray. And listen obediently. This sounds obvious. But I was very conscious of Psalm 127:1 'Unless the Lord builds the house, the builders labour in vain. Unless the Lord watches over the city, the guards stand watch in vain'. I asked trusted friends at church to pray with me as I sought God's will.
Did you go with a mission agency?
I didn't, but was sent by my church. I attend a large church experienced in sending members overseas, and two members supported me prayerfully and pastorally as I planned, prepared, and went. In future I would consider going with an agency; they can help with planning many practical aspects, as well as support while overseas and help with debrief afterwards.
Didn't you feel underqualified as an 'F3'?
Having already spent time in the hospital, I knew what support was available. Without this, I would have been cautious in checking that my host project was clear about what to expect. It was a steep learning curve, particularly as I was expected to work independently, but I was fortunate to have supportive colleagues.
What did you do to prepare medically?
CMF's two-week Developing Health Course, with themed days for different specialties, plenty of practical sessions and time for fellowship and discussing mission, was invaluable. When I had to undertake my first emergency intraosseous needle in Madagascar, I was so thankful that I had been able to practise.
You went for three years - why so long?
It was important for me to get to know and invest in my community, so I could learn from them, and then carefully consider implementing change and then sustaining it. I valued the continuity of remaining in one place after the rotations of Foundation years. I learned local languages to a fluency that I could see my patients independently without an interpreter, teach in church, and understand local folk chatting.
I became increasingly aware of the importance of taking the time to learn and understand the local culture, and how this influences medicine and health beliefs. In Madagascar, pregnancies do not have nine months, they have ten moons. I was able to learn about how local animistic belief systems worsened childhood malnutrition, and about health beliefs regarding chronic illness.
The time and effort helped me better serve my patients. I was able to explain the gospel to my patients and pray for them in their heart language. I was able to go to more rural communities for a week at a time, undertaking consultations, health promotion and evangelism. I was able to get involved in the wider community, regularly supporting a rural village church most Sundays. Many of these opportunities would not have been possible during a much shorter visit.
What about applying for specialty training after time out? It is possible to take up to three years out after completion of Foundation training, and still use the certificate as proof of attainment of Foundation competencies when applying for specialty posts.
Many people, including Christians, were critical of my plans, and told me it was 'career suicide' — I would not be competitive and would never be able to get a training job again. However, I felt peaceful about this. I knew that Madagascar, for that time, was where God wanted me to be. God never promised me a training job to come back to - but he has promised a hope and a future. The same God that I trusted to lead me to Madagascar can also be trusted to lead me into the next chapter. In the end, I was successful in obtaining specialty training offers with very competitive scores in both of the specialties I applied to, which was testimony to my sceptical colleagues.
Looking back. I recently visited Madagascar again, a few years on from my three-year service. I have so much to thank God for and rejoice over. Of course it's not all perfect; there have been many challenges over the years. But students I helped to teach and train in the nursing school are now qualified nurses. Systems and protocols that I helped to instigate are still being used. I have been able to see some of the babies and children that I cared for, now growing and thriving.
I visited the rural village whose cell church I used to support weekly. Three years ago, they were meeting under a palm tree. Now, mud bricks that I helped to make form the walls of a completed church. As I walked the red dust tracks to reach the church building for the first time, I could hear the sound of worship echoing across the valley. Adults who had been young in their faith and newly baptised, are now teaching and serving. I had the privilege of witnessing how God is building that church in wisdom and in number, for his glory.
The harvest failed this year, which has been catastrophic in a predominantly illiterate, subsistence farming community. Despite this, my friends shared sacrificially with me and continued to treat me as one of them, as if I had never left- an immense honour. When I first came to Madagascar as a medical student ten years ago, I imagined that I would share and teach and would also learn. But I could never have imagined the extent to which God has used my time overseas, my three-year 'F3', to teach me so many lessons, to make me daily more like him, and to show me his love for his people in the place that he has put on my heart.By his grace he has allowed me to be a part of that and to serve here, and I wait and pray expectantly for what he has planned next.
