The Soavinandriana Hospital Centre (Cenhsoa) launched celebrations of its 135th anniversary today. The occasion provides an opportunity to review the establishment's evolution through the account of Dr Raymond Sambany, a living memory of the military hospital.

Dr Raymond Sambany, 72, embodies four decades of military hospital history. He joined as a volunteer surgeon in 1986, witnessing key periods from foreign cooperation to the hospital's independence. He worked alongside all Malagasy general directors, including Prof Razanamparany, Prof Rakotovao, Prof Razafindramboa, Prof Rajaonarison, Prof Fanomezantsoa Rakoto, and Prof Willy Ratovondrainy.

Dr Sambany is also a witness and actor in Madagascar's surgical evolution. "When I arrived, the establishment operated under foreign cooperation. All services were managed by foreigners. Everything was available—operating room cabinets overflowed with instruments and supplies immediately accessible to surgeons and anesthesiologists," he recalls. He remembers that on-call surgeons treated all emergencies, from neurosurgery to fractures, appendicitis, or emergency cesareans. "The only priority was saving lives," he says, recalling youthful apprehensions quickly dispelled by routine.

The major turning point came around 1994 with Malagasy medical teams' autonomy. "Many Malagasy specialists, civilians and military, returned to Madagascar. They believed they could function independently without cooperants. Foreign presence gradually decreased, with ophthalmology being the last service they managed," he recalls. Autonomy brought administrative rigor and new demands.

"When the hospital became autonomous, prescriptions were established for pharmacy supplies," he explains. This autonomy allowed practitioners to focus on single specializations. "A visceral surgeon no longer performs trauma surgery, for example. This improves medical care quality but reduces the versatility of previous skills," he continues.

Dr Sambany became a pioneer of surgery at the establishment. Due to his expertise, the hospital retained him after retirement. As a member of the Malagasy team performing closed-heart surgery autonomously since 2016, he became one of the country's first surgeons trained in open-heart surgery, practiced in Madagascar since early 2024—a major advance for Malagasy medicine, though these interventions still benefit from French medical team support for five years. Previously, patients needing such procedures were evacuated abroad.

Dr Sambany sees this hospital as fulfilling a commitment made thirty years ago: autonomous medicine driven by Malagasy expertise. "Compared to foreign hospitals, equipment gaps remain, but the hospital achieves excellent standards allowing quality operations," he concludes.