Tsiferana Rakotoarisoa: Smile Train’s Patients Give Me Hope

Tsiferana Rakotoarisoa is Smile Train’s Program Manager for Madagascar. In honor of International Women’s Day, we sat down with this extraordinary woman to discuss why Smile Train’s model of empowering community healthcare workers is indispensable for Malagasy children with clefts, the unique challenges of working in her country, why she calls herself a “hopelessly hopeful person,” and much more.

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Tell me about your journey to Smile Train.

I was working as the operations manager for a German NGO hospital, Mobile Hilfe Madagaskar, when I applied to this position. Prior to that, I volunteered with Mercy Ships for almost four years. I started as assistant to the medical capacity building (MCB) course coordinator. Though based on land, that role taught me to swim in the sea of logistics and project management. From there, I followed the ship and became the MCB program manager in three different West African countries. I encountered most of my humanitarian connections while volunteering abroad. That is how I learned about Smile Train; one of them suggested I apply for this position in 2020, but I turned it down due to family reasons. Then a year later, another Mercy Shipper suggested it again, and I felt it was time. I have been in this position for a year now and have benefitted from constant advice and guidance from our other remarkable program managers around the world. So despite the challenges, it has been a great year of firsts in my country.

What has it been like to work for Smile Train? What appealed to you about this position?

I love meeting people, learning from them, sharing my skills with them. And that has happened every day since I started this job. Most of the lessons have come from patients and parents… their bravery facing their difficulties will never cease to amaze me. It gives me hope that, though life can be hard sometimes for everyone, the key is to be grateful no matter what. It is this message of hope that appealed to me. Capacity building has always been an important project for me. After all, what are we alive for if not to do better than the day before?

Is there a patient who particularly inspired you?

I’ll never forget the first patient I met. His name is Mickael, and I cried when I first saw him. My nephews and niece are all chubby babies, so to meet a three-year-old toddler who was skin and bones, not walking, and could not chew correctly because he had a cleft…. His dad said that his wife only breastfed him once and he nearly died. Traumatized, she never accompanied him to a check-up or doctor’s appointments since. Any time I saw Mickael, he was with his dad. Today, Mickael is four-and-a-half, has a new home, a dad with a job in the city, and a mom who is learning to take care of him step by step. But most of all, he has an incredible and wonderful smile.

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What was it like for you as a woman to start the first cleft speech program in Southern Africa?

This program was only possible thanks to the perseverance of Sibusisiwe Yona, our Program Director for Southern Africa. She found our main partner in Antsirabe, and I’ve since had the chance to work with their very engaged and enthusiastic cleft team. I think that good, pre-established relationship went a long way towards helping us inaugurate them as the first speech program in Southern Africa. I think being a woman has helped me be a better Program Manager, as I find that people are more open to discussing children’s futures with a woman. Not to mention that the majority of healthcare workers here are female. But I prefer to think of my successes as due to hard work and determination rather than my gender.

What are your strategies for raising cleft awareness and growing programs?

In a country where technology is still a work in progress, we really do what we can to reach out for patients. I happen to have a connection with the Association of Scouts in Madagascar; they are my eyes and ears in the field, as they travel many kilometers a day selling cookies and cakes, especially in remote areas. I made sure they always carry Smile Train pamphlets with them. I also use social media to promote awareness and connect parents to each other, like the Friends of Smile Train in Madagascar Facebook page. Giving awareness grants to our partners also makes for successful patient recruitment campaigns.

What more can be done to strengthen our programs in Madagascar?

Any time I go to meet officials or high dignitaries, I am always receiving that look of Smile… what? I think more publicity would go a long way in my region. People with clefts here tend to hide in their homes, and I think more awareness programs would help get them out. I want to not only promote the safety and quality of the surgeries we sponsor, but also advertise more on what makes Smile Train unique: our model of community-based, long-term, comprehensive cleft care.

What are some of the unique challenges of working in Madagascar?

First, when there is another cleft NGO with a strong partnership with the government and huge visibility around the country, it is challenging to advocate and make a name for yourself. Second, reaching out to patients and coordinating logistics with them is very difficult due to bad roads in most regions. Finally — though I think this is more a universal thing than something regional — it is hard to say no to people. I am happy to help people in a compassionate and loving way; sometimes, though, I have to admit that I can’t. Or that I have other priorities, or that I do not have the budget for a certain kind of initiative. That is a real struggle for me.

Why is Smile Train’s cause and model meaningful to you?

I am hopelessly a hopeful person. Going to work every day to not only help give smiles to others through safe and high-quality surgery, but also changing their world with a definite program of personalized, long-term care gives me a thrill. Knowing that I am part of something bigger is the fuel that I need to accomplish my goals

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Why is doing this work for cleft treatment, specifically, so important to you?

I like humanitarian work. I spent four years volunteering in different countries because helping people is what I do best. Now I can help my own people and their children. This is significant to me.”

What is your message to the global cleft community?

I am forever grateful to be part of this community. Thank you, and let’s get back to work.

What is your ultimate hope for healthcare across Africa?

This is such a difficult question because it is so related to many other factors. I could say equity in healthcare, though the problem lays deeper. So, I am just going to say I want to see more trained, able, and well-paid doctors who choose to stay and work in their countries; more well-equipped and well-furbished hospitals that are properly running; and most of all, fewer patients dying due to a poor health system and bad governance.