Regarding our unit for patients with spinal cord injuries, we have decided not to take new patients until now because of the difficulty in managing the situation, especially since patients who arrive at the neurosurgery department are very rare. We do home follow-ups for patients who live around Tanà and by telephone for those who live outside Tanà. Currently, there is a project called the MAHERY project; funded by an NGO Christoffel Blinden Mission (CBM) and in partnership with the Ministry of Health and the AMPRMada Association which will strengthen the prevention of disability and provide health quality care services for patients (paraplegics, hemiplegics and amputees) in 3 regions (Antananarivo, Tamatave and Majunga). This project will last one year.

Finally, the African Spinal Cord Injury Network [AFSCIN] conference that Dr Andréa and I participated online using Dr Andréa's computer. We were not able to follow regularly because of connection problem, availability problem and problem of language. We are also not used to doing international meetings online. However, we tried our best and have requested the organisers to kindly share the presentation so that we can watch them together when we have time and better internet access.

It is encouraging to note that the Rehab team have not only managed to keep their services afloat during this crisis but have gone beyond their call in supporting the situation in areas that are outside their comfort zone. We at GR are proud of our colleagues who feel confident to continue to lead the rehab services and support other acute services. There can be no better recognition of expertise and teamwork.

GR is delighted to have been able to reach out to our Malagasy colleagues and address their need to have uninterrupted internet access. Thanks to the kind donations from our supporters, we have now transferred sufficient funds to pay 20 members of APMR Mada to get internet access for 1 whole year. This we feel confident will go a long way in meeting not just the professional development but also improve communication with colleagues both nationally and internationally. We look forward to starting to meet them virtually more regularly to plan further training and service developments.

Facing the 2nd Covid wave.

Here are some updates from our colleagues in Madagascar who, despite the dire situation in the country have been offering their expertise and time to help people with disabilities who have been affected even worse in terms of inability to access routine rehab input.

Here is what Dr. Sonia Andrianabela, who spearheaded rehab services in the country and is now retired has to say.

‘We had to face a second Covid 19 wave which is more lethal than the first one due to the South African variant. Some regions including Antananarivo, Antsirabe, Fianarantsoa, Toamasina, Mahajanga and the north have been affected. New cases have decreased, the situation is a little better, but we still have imposed constraints with lockdown measures.

We have started the vaccination with the Covishield vaccine, targeting first health staff, security personnel, elderly people, people with co- morbidities. Embassies and United Nations organizations use other types of vaccines.

All rehab centers are working, but sometimes with staff restrictions as some of them get ill or sometimes especially in the regions, they are called upon to help with the management of covid patients.’

Dr. Rakotonirainy Jean Jacques Renaud, head of rehabilitation services at Tana and lead for spinal cord injuries rehabilitation in the country updated us regarding the impact of the pandemic on his services.

We had a difficult time because of the current situation, on top of that we had connection problems in our establishment, fortunately everything is now back to normal. Indeed, there are a lot of staff restrictions for each rehab service. For example, in our service there are about ten staff who have tested positive, fortunately none of us have had a serious form. Some staff are called upon to reinforce the COVID treatment centers. There are not many outpatients due to the fear of coming to our establishment. This situation is almost the same in other rehab services.