Faith, Hope, Love, and Health

A letter from Doug Tilton, Regional Liaison for Southern Africa, writing from Madagascar

September 2017

Write to Douglas Tilton

Individuals: Give online to E200416 for Douglas Tilton’s sending and support

Congregations: Give to D507200 for Douglas Tilton’s sending and support

Churches are asked to send donations through your congregation’s normal receiving site (this is usually your presbytery).


Dear Friends:

It is 6:30 a.m. in the remote village of Andolofotsy, a six-hour drive from Madagascar’s capital, Antananarivo. Léa Harilalao opens the door and looks across the road to the thatched shelter where a dozen or so people have already begun to congregate. “The dispensary is only meant to open at seven,” she laughs softly, “but, as you can see, people come early.” So, often—when she does not have visitors to look after—Harilalao, a midwife, begins to examine patients well before 7 a.m.

Today, though, she graciously makes time to introduce us to her work and to the community she tirelessly serves. Harilalao runs the dispensary at Andolofotsy, one of 36 largely rural dispensaries established around the country by the Development Department (SAF) of the Church of Jesus Christ in Madagascar (known by its Malagasy acronym, FJKM). This is also one of seven facilities that SAF has opened with assistance from Presbyterian World Mission—which is why I have joined Dr. Josoa Randrianonivelo, the head of SAF’s Health Program, and Pastor Paul Razafintsalama, the president of the local FJKM regional synod, to visit the area. Several other PC(USA) mission co-workers are also with us, including Elizabeth Turk, a public health nurse—and indispensable translator—who works with the SAF Health Program.

SAF recruits medical professionals—typically doctors, nurses or midwives—and provides them with premises, a six-month supply of basic medicines, and ongoing supervisory support. The nominal fees that the practitioners charge for consultations and medications enables them to support their families, replenish their stocks, and provide a vital community service in a sustainable manner.

For her paramedical degree, Harilalao did two years of training in general medicine, followed by a year of specialized training in midwifery, so she is equipped to treat most of the common health complaints of the residents of Andolofotsy and surrounding areas.

The dozen or so clients who have gathered this morning in the open-sided waiting area are fairly typical. Several are there to have illnesses treated, either their own or their children’s. Others have come to have wounds dressed, to seek help with family planning, or to get medication for chronic maladies. One man has cycled six miles over rugged terrain in the hope of getting medicine for his stricken father. (Sadly, though not surprisingly, Harilalao explains that she is not able to dispense medication without examining the patient.)

The townspeople are clearly grateful for Harilalao’s presence and the good care that they receive from her. “Before the SAF dispensary was here, life was very difficult,” a woman in her sixties told us. “People died because they did not have options for care.”

In fact, the main concern that we hear expressed frequently during the day—even by municipal leaders—is that Harilalao occasionally has to go out of town for training in the latest medical protocols and procedures. Residents worry that someone will fall ill during one of those periods when the community lacks medical expertise. Dr. Josoa assures everyone that SAF is working on finding an assistant for Harilalao to ensure continuity of care.

While the head of the municipal district is effusive in his appreciation for the dispensary and for Harilalao’s work, a visit to the local primary school provides further indication of the facility’s importance. As we move from class to class to greet the teachers and the students, we ask one of the classes how many of the pupils have been treated at the dispensary. Roughly half of the children put up their hands.

Later in the day, when Dr. Josoa sits down with Harilalao to review her records and advise on any questions or challenges she has encountered, we learn that she has had more than 4,000 consultations with clients in the previous year. That is a substantial figure, given that the population of the entire district is estimated at 21,000!

But it is not just the medical treatment that people appreciate. Members of the community are also quick to point out that Harilalao lives among the people and is active in the local FJKM congregation. To enthusiastic nods, Dr. Josoa explains to clients that the dispensary is really a ministry of the church and that Harilalao is more than a midwife; she is also a church worker. The presence of Pastor Paul and two of the local FJKM Katekista Delege [similar to commissioned lay pastors in the PC(USA)] help to highlight the extent to which health ministries are an integral part of the overall care that the church provides for the community.

The SAF Health Program is just one of the many ways in which the FJKM is touching the lives of millions of people across Madagascar, sharing the good news of God’s love in Jesus Christ in a holistic manner so that all may experience life in abundance. I am so thankful for your prayers, letters, and gifts, which are a concrete sign of your partnership in God’s mission and which inspire and support me—and mission co-workers like me—as we accompany our partners in Madagascar and around the world. Please continue to grow your commitment to PC(USA) mission co-workers and the partner ministries with which they work.

Grace and peace,


Gifts to support Doug Tilton’s ministry may be sent to E200416 or to Designated Mission Support account D507200. If you or your congregation would like to support SAF/FJKM’s health ministries, please send gifts to ECO Account E047979 (FJKM Community Health).

Please read this important message from Jose Luis Casal, Director, Presbyterian World Mission

Dear Friend of Presbyterian Mission,

What a joy to send this letter! As Presbyterian World Mission’s new director, I thank God for your faithful support of our mission co-workers. The enclosed newsletter celebrates the work you made possible by your prayers, engagement, and generous financial gifts. We can’t thank you enough.

After I began in April, I met with mission co-workers and global partners and was blessed to see firsthand the mighty ways God is working through them! Our global partners are asking us to help them move forward with life-changing ministries. Because of your support, we can say “yes” to these creative and exciting initiatives.

I write to invite you to make an even deeper commitment to this work. First, would you make a year-end gift for the sending and support of our mission co-workers? We need your gifts to end the year strong. With your help, we filled two new mission co-worker positions and plan to recruit for others. The needs in the world are great, and World Mission is poised to answer the call to serve.

Second, would you ask your session to add our mission co-workers to your congregation’s mission budget for 2018 and beyond? Our mission co-workers serve three-year or four-year terms. Your multi-year commitment will encourage them greatly.

Our mission co-workers are funded entirely from the special gifts of individuals and congregations like yours. Now more than ever, we need your financial support.

In faith, our mission co-workers accepted a call to mission service. In faith, World Mission sent them to work with our global partners. In faith, will you also commit to support this work with your prayers and financial gifts?

With gratitude,

Jose Luis Casal

P.S. Your gift will help meet critical needs of our global partners. Thank you!

Creative_Commons-BYNCNDYou may freely reuse and distribute this article in its entirety for non-commercial purposes in any medium. Please include author attribution, photography credits, and a link to the original article. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDeratives 4.0 International License.

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