Qiang Yaosheng checks a patient at a free clinic for local residents in Madagascar. [Photo provided to China Daily]

Years after their missions were completed, many Chinese medical doctors still remember their patients in Madagascar, an island country off the southeastern coast of Africa.

Similarly, many Malagasy patients will be forever grateful to the visiting doctors who helped change their lives.

During his first mission to Madagascar in 2010, Qiang Yaosheng, a surgeon from the First Hospital of Lanzhou University in Gansu province, treated a 13-year-old girl suffering from severe intestinal obstruction. Her family could not afford the surgical supplies needed for the emergency operation, so Qiang used his own savings to ensure the surgery proceeded.

Two years later, shortly before completing his mission, Qiang was walking along a rural road when a young woman suddenly recognized him. "Thank you, Chinese doctor!" she called out.

Qiang soon realized it was the girl he had treated.

For Chinese medical workers in Madagascar, the phrase "Thank you, Chinese doctor" has come to reflect decades of trust built through medical care and personal connections.

He Fengxiao, a cardiac surgeon at Lanzhou University Second Hospital, joined a medical mission to Madagascar in 2023, and experienced a similar sense of trust that extended beyond the hospital setting.

"People knew we came there to save lives. We treated many complicated conditions and helped many locals recover," he said. "When we walked outside, local residents were very friendly and greeted us from a distance."

That trusting relationship has been built patiently over more than half a century.

Since 1975, a total of 24 medical teams from Gansu have served in Madagascar, with personnel making 725 visits, some multiple times. The teams have treated 5 million patients and performed over 130,000 surgeries, according to the Gansu Health Commission.

This effort is part of China's broader medical cooperation program. In December 1962, following a global appeal from the newly independent Republic of Algeria for emergency medical assistance, the Communist Party of China was the first to respond and sent its first international medical aid team the next year.

Over the past six decades, more than 30,000 visits by Chinese medical workers to 76 countries and regions have been made, providing care for nearly 300 million patient visits and supporting over 130 medical facilities, according to China's National Health Commission.

As the number of CPC members in the medical teams grew, Party branches have been established locally to organize study sessions and collective activities, helping strengthen coordination and unity among team members.

From the early days, Party members often took the lead not only in medical work, but also in adapting to life overseas and building connections with local communities.

He Fengxiao operates on a patient whose chest and abdomen were pierced during a building collapse caused by a cyclone. [Photo provided to China Daily]

TCM opens doors

When the first Chinese medical team from Gansu arrived in Madagascar in 1975, one of the biggest challenges was not treating diseases, but gaining the trust of local patients.

At the beginning, few people came to seek treatment. For more than 10 days, Chinese doctors looked for ways to connect with the local community.

Tang Shicheng, former deputy director of Gansu Provincial Hospital of Traditional Chinese Medicine, decided to begin with acupuncture, a traditional Chinese medicine treatment he was familiar with.

He demonstrated it on himself, inserting needles into his own leg.

Curious locals asked whether it hurt. Tang said "no" and invited them to try acupuncture. "After that, patients gradually began to come in, and queues soon formed across departments. That was how our work began," he recalled.

Tang's acupuncture treatment was embedded in locals' memories. In the 1970s, a Malagasy newspaper in Ambovombe reported how Chinese doctors brought hope to patients through TCM, describing some recoveries as "miracles".

One patient, Fotoa Jean Jacques, who suffered from paralysis, gradually regained the ability to speak and walk after receiving acupuncture treatment from Tang.

Wang Jiaqi, former deputy director of Gansu Provincial People's Hospital, said trust was already established during his mission in the 1990s. Wang said a former Madagascar ambassador to China regularly turned to the Chinese medical team for treatment, though he had many doctors in his own family. "He told us that what impressed him most was the dedication of Chinese doctors, their careful treatment of Malagasy patients and their willingness to serve the people here," he said.

Qiang treated a complex case involving a large thyroid tumor. To reduce surgical risks, his team carefully optimized every step, from preparation for surgery and anesthesia planning to incision design.

"After the surgery was successful, word quickly spread," Qiang said. "Relatives of a Malagasy official even reached out through overseas Chinese networks to seek treatment from us. That kind of word-of-mouth recognition is the strongest confirmation of our clinical work."

Over time, Chinese doctors became a familiar presence not only in hospitals but also in the broader community. Overseas Chinese and employees of Chinese enterprises in Madagascar regularly sought their help, while patients from neighboring island countries such as Comoros and Mauritius even traveled by boat for treatment.

Doctors from Madagascar receive training from their Chinese peers at Lanzhou University First Hospital. YANG MINGZE/FOR CHINA DAILY

Stronger local capacity

When the first Chinese medical team arrived in Madagascar in 1975, the local medical environment was vastly different from what they had experienced at home.

Hospitals often faced shortages of equipment and supplies, forcing doctors to make difficult decisions in restricted conditions.

Even today, many regional hospitals continue to deal with limited equipment, shortages of supplies and unstable power. For doctors, an operation might involve unexpected challenges.

"There were even flies during surgery," said Wang Jianhua from Gansu Provincial People's Hospital, who served in Madagascar for four years from 2018. "We had to improvise. We could not stop, because the patient would die."

In rural areas, the pressure was even greater. A single doctor could be responsible for tens of thousands of residents, Qiang said.

For many Chinese doctors, improving local healthcare started with solving problems they encountered every day.

He Fengxiao recalled that some surgical procedures in Madagascar were delayed because patients' families needed to purchase basic supplies such as gauze and sutures after doctors decided to operate.

"For some families, these materials were a heavy financial burden. They had to borrow money, which could affect the progress of surgery," He said.

To address this, Chinese medical teams prepared emergency kits containing commonly used surgical materials to ensure urgent procedures could proceed.

Since 1975, Chinese medical teams have continued to provide medical supplies and equipment, either purchased by the teams themselves or donated from within China. Support gradually expanded from basic surgical instruments and medicines to advanced equipment such as digital X-ray machines and CT scanners.

In recent years, that support has included advanced diagnostic equipment. A digital radiography system, donated with support from the First Hospital of Lanzhou University, was put into operation in 2026 at the University Hospital Center of Anosiala in Ambohidratrimo, Madagascar, improving imaging diagnosis.

Previously, medical staff relied on slower and less precise imaging systems, and patients sometimes had to travel long distances for further examinations.

The new digital system has helped shorten examination times, improve image quality and make medical diagnosis more accessible for local residents.

Chinese medical teams have also continued to train local doctors, introduce standardized procedures and help build a more sustainable healthcare system.

He said thoracic surgery was once limited by shortages of equipment and lack of standardized procedures. In some chest trauma cases, local doctors had to rely on improvised containers instead of proper negative-pressure drainage systems, posing safety risks.

Chinese doctors helped introduce medical instruments to local doctors, demonstrate standardized procedures, and train local teams through case discussions and surgical guidance.

"Medical cooperation is not only about treating patients, but also about helping local doctors develop the ability to handle more complex cases independently," He said.

Ma Shirong examines a patient in Madagascar. [Photo provided to China Daily]

Training, exchanges

In the respiratory and critical care ward of the First Hospital of Lanzhou University, Malagasy physician Rabeson Tahiana follows Chinese doctors during routine rounds.

Moving from bed to bed, they discuss patients' conditions, sometimes using AI translation tools to bridge gaps in language and medical terminology.

Tahiana and four other doctors from the University Hospital Center of Anosiala, Madagascar, are currently participating in a six-month training program at the hospital. They observe clinical practices, participate in daily medical work and learn from Chinese doctors across different specialties.

"The Chinese doctors are highly skilled and well organized," Tahiana said.

The program provides access to advanced respiratory technologies, including bronchoscopy and pulmonary function testing.

"This training allows us to bring new techniques back to Madagascar and improve care for our patients," he said.

Rasolohery Honjaniaina, who has worked with Chinese medical teams in Madagascar for six years, said the cooperation had continuously improved her clinical practice.

"Each Chinese colleague has helped me in my daily work. It has been a valuable experience of exchange and learning," she said.

For Chinese doctors, the goal of training is to support the development of a self-sustaining local medical workforce. Knowledge and skills learned in China, they said, will become part of the local healthcare system and continue to benefit communities.

"China's medical technology is developing rapidly. Coming here allows doctors to learn new knowledge and methods. We share our experience without reservation," Wang Jianhua from Gansu Provincial People's Hospital said.

Chinese medical team members work with Malagasy staff to prepare disinfectant in a laboratory. [Photo provided to China Daily]

A shared responsibility

Over the past five decades, Chinese medical assistance in Madagascar has continued across generations, carrying forward both professional skills and a shared sense of responsibility.

When Ma Shirong, a CPC member and a physician from Gansu Provincial People's Hospital, first arrived in Madagascar in 1990, he brought a Xinhua Dictionary to assist with daily work. When his mission ended, he left it to the next team, writing on the first page: "Please cherish it and pass it on."

Years later, doctors who used the dictionary told Ma that the small book had helped them greatly during their missions.

"For me, it was not just a dictionary. It carried the experience and memories of generations of medical workers," Ma said.

The missions also reflected the continuity of the teams' discipline and sense of responsibility while overseas.

They cleared land, planted vegetables and dried local fruits such as lychees to improve their lives. They also invited locals to join in activities such as planting trees and working in the fields, creating more opportunities for mutual understanding and friendship.

This spirit of unity continued with teams that worked on Chinese enterprises in Madagascar. The China Railway 18th Bureau, for instance, carried out joint Party activities such as studying China's diplomatic policies and organizing health education programs on common diseases.

For Chinese medical workers, overseas missions also mean representing their country through everyday interactions.

"People may not know your name, but they know you are Chinese. Your words and actions can influence how they see your country," He said, adding that this awareness encouraged him to communicate more with local residents and pay closer attention to his behavior.

"When you are overseas, you understand the meaning of your motherland more deeply," Wang Jianhua said. "Seeing the Chinese flag far from home reminds you of where you come from and the responsibility you carry."

Today, cooperation between Gansu and Madagascar continues to evolve, with a new team carrying forward the experience, skills and commitment built by generations of medical workers.

Earlier this year, China launched its initiative of "100 Medical Teams in 1,000 Villages", setting a goal of conducting more free clinics and medical consultations in about 1,000 residential areas of host countries by 2027.

A Chinese medical team from Shandong province has been working on health education and free consultation activities related to schistosomiasis in Tanzania. They also visit schools and local orphanages to treat children and donate medicines, earning widespread praise from the local residents.

The Zambian government on Friday commended the 26th Chinese medical team from Henan province for its contribution to improving healthcare delivery in the country.

Yang Mingze, Wu Yuexuan and Tong Yunshan contributed to this story.