Sylvia's Journal

I was given the luxury family suite in the not very attractive looking hotel right in the center of the town of Moramanga, some 100 kilometers from Tana. It was very Chinesy looking and I am sure all the hotel decorations had been trucked in on one of those tractor trailers years ago. The Chinese and the Malgache have intermingled for a long time – they may have been the Chinese from Malaysia or further northeast. Some go back to the 1800s.

Some Malgache look decidedly Chinese. Unlike the Indiens and Pakistanis who some fear are now in a more stealth way taking over the country, the Chinese were and are rather quite open about their infiltration. There are major construction projects all over the place. They would do poor families a favor if they could fix route national 42!

I noticed how development here (and probably elsewhere) is both brute and tender at the same time. The brutish part is the Cartesian, mechanical, engineering-dependent exploitation of primary resources with a focus on gain and short term profit. And then there are the people who we met who sacrifice much (so much more than we would ever agree to sacrifice, we wimps); the young idealists from here and abroad who study trees and plants, the ecology, to ‘unexploit’ it, to reforest, replant, make healthy again all life, human and other; those are the people with the long horizon, who focus on the other bottom line, who are driven by care.

But, people will say, we cannot abandon the trucks and the containers because the goods provide livelihoods for so many people who come to Tana, and initiate the detail commerce from there on, fanning out to the next level capitals where commercants of an even more petite entreprise continue further down, all the way to the tiny wooden shacks in the villages that sell the fake plastic Barbie dolls (pink with yellow hair), the soccer shirts, the leggings and the cheap tools that came in from (probably) China.

And while all this driving to and fro is done, the trucks gouge what remains of the secondary roads so that the people who have the bad luck of living far from a health center choose dying at home over dying a horrible death on the road (there are no painkillers!)

The trucks also do terrible things to the lungs of the more vulnerable members of the population who live and toddle along the road, breathing in the fumes all the time, if they don’t get run over. Brutes and tender(er)s.

I somewhat dreaded the long way back to our next interview which would be along Route National 2 that connects Tana to Tamatave. It would be first the ferry, 30 minutes this time because we went with the current, then another hour of the undulating sand piste, then another 3 hours to the main road and then another two hours west. We would arrive at sundown. And we did, also in the rain, at the next, and our last, health center.

The path to the health center was up a slippery red clay road. The doctor was running around, her white coat flying, as she was trying to induce an abortion of a woman who had walked 2 days while in labor. The baby had died inside her before she arrived at the health center and needed to be aborted to save the life of the mother. If only Trump and his prolife supporters would see this, I wished. I suspect Trump has probably never heard of Madagascar and couldn’t point to it on a map if his life depended on it.

While she was putting the traumatized woman on the abortion-inducing drip we talked with another woman who was waiting to see the doctor, 6 months old baby on her hip. She looked healthy as did the baby who smiled at us. It was her 11^th child (she was 38 and had her first child at 16). The baby was called Sunday the 11^th. She was here because the baby had diarrhea.  We asked about family planning. A woman behind her whispered in her ear ‘we don’t like it.’ ‘Husbands don’t like,’ corrected the doctor. They are not making good inroads on family planning yet. For now she concentrates on prenatal visits, especially the last one and delivery in the health center. She had reached the target she had set for her team. This was illustrated when we finally sat down in her office after she had seen the baby with diarrhea. By now it was pitch dark and we took notes with the help of our smart phones’ light.

The doctor had done what her higher ups only write (and dream) about:

1. She mobilized community and local health personnel to contribute to the purchase of delivery kits – when women come to a health center and don’t have two bottles of water, a piece of clean linen, a clean shaving blade and more they are sometimes sent away. The kits are to keep this from happening – but some kits are accumulating where they are not needed and not available where they are, like here.
2. She bought a blood pressure cuff (about 125 dollars) from her own pocket as the one at the center was no good anymore. She could not wait for a new one that might never come and couldn’t work without one. She does not expect reimbursement (things don’t work like that here).
3. She mobilized the Commune to raise money and build four ‘cases d’herbegement’ places where the pregnant woman who is about to deliver can wait the last few days with her family so that she doesn’t have to walk for days while in labor like her unhappy sister on the drip in the room next door. We visited the two cases that were occupied with expectant families. Three cases are already completed and a fourth one is being built.

We asked what else was different since she completed the leadership program. She told us that she had never had an experience that gave meaning to the word ‘objectif’ (goal) until this program. She liked what it did to the team and is now also setting herself a goal to buy a piece of land and construct a house in Mahajuna on the west coast before the end of 2018. This will bring her closer to her vision of a happy family life. Currently her husband lives in the far southwest corner of Madagascar, about two days of travel (with a good car); her baby is with relatives in the capital. This means she is alone and on duty 24/7. She loves her work (which would explain the sacrifices). She  cares deeply about the women in her community.

Our third and last sweep to visit teams that had participated in the keadership development program was to the coast. We travelled all day on Monday, a holiday, to get to Tamatave, on route nationale 2. It is mostly a good road, which means people drive too fast. It is also a good road while it last. There are many 60 ton tractor trailers, some with as many as 30 wheels. They are loaded to the gills and then some (bananas and other local produce added by folks along the road – which I am sure is not alllowed). They truck the large containers with stuff from China and elsewhere to Tana for further distribution throughout the country by ever smaller means of transport.

Here and there the asphalt is starting to give and it is just a matter of time and a few more of those heavy trucks before it is gone. I have never understood the utility of the truck weigh stations as well as here. I have seen a few of them here, though none were in use.

Notre Dame de la route stands at the start of the paved road in Tamatave. She has to compete with the testosterone which is illustrated by texts on trucks: “Bad Girl Edition” and the “Need for Speed.” Notre Dame was on our side this trip but we saw a few turned over tractor traulers and some other wrecks where the need for speed had clearly won.

We had a flat tire about 3 hours into the trip. The jack turned out to be too small size for our 4×4. We searched for stones, anything hard, in the wet red clay but every stone crumbled under the weight of the wheels. A truck parked further down the road lent us a better jack and we got back on our way. I appealed to Notre Dame to keep us from having another flat tire before the flat one was fixed in the next place where we could do this, one and a half hour away. She listened.

While the tire was being fixed we ate at a sketchy roadside restaurant. I discovered a few hours later that I had eaten more than a fried fish and ingested something my body did not like at all. Once we arrived in Tamatave, one of the more desolate places I have been to lately (I commented to my road compagnons that this felt like a city without a vision) I also felt increasingly terrible inside.

I ate my dinner reluctantly knowing something was wrong. This proved to be correct when a blew my dinner once back in the hotel. My body kept busy throughout the night to remove whatever bug I had eaten that didn’t agree with me. It was an exhausting and sleepless night that left me in a pretty poor state for another day of driving over bumpy roads.

I was miserable all day, wondering all the time, are we there yet? When we finally arrived at our destination it was dark and we met the team in a dark district health office (no electricity) assisted by smartphone lights. In the middle of the interview I became nauseous again. I was taken out to the hospital grounds to vomit wherever I wanted. I suppose there are animal brigades that clean things up here. But nothing came out as I has not eaten for nearly 24 hours.

My team mates decided that the local hotel would not do for someone as sick as me and took me to the convent and handed me over to the care of the nuns. And care they did! They prepared a room for me, two buckets to accommodate expulsions from top and bottom, put a tray with toast and a thermos with hot water for tea next to my bed, lit a candle and bade me good night. they probably also said a prayer for me I suspect. they forbade me to leave my room and use the buckets. No shame. I had a good night.

I was woken up by the singing of the nuns this morning and the sound of a 100 birds. I already feel better. The bug is gone.

All healthy again we embarked on another adventure after the sisters released me. Although they told me that taking the ferry to the next health center was very uncomfortable, I told the team, worried about my state of health, that I was fine and that we should go.

The 15 kilometer road to the ferry took us an hour. It was like an undulating sand path, about the width of two cars, every valley was a pool of water. And so we went at about 10km an hour swish/splash/swish/splash occasionally interrupted by straight stretches in 2nd gear. When we got to the ferry I asked where the ferry was, seeing only what looked like an embarkation. Then I was told that that was the ferry itself – a square piece of wood planking of about 6 by 10 meters put on top of 5 metal boats soldered together at a right angle to the platform. We were advised not to take the car as it would make the trip longer. And so we pulled out two of the small stools that my team mates had bought along the road and positioned ourselves on the wooden platform.

It took the battery of our rental car and much banging and clanging with spanners and other tools borrowed from the little snack bar to get the motor started. It may have dated from the turn of the previous century, making lots of noise and spewing black smoke.

We could see why the health center had never seen anyone there from the ministry – it took a lot of conviction to go there, basically two days of travel from the center.

When we arrived a small boy walked us to the health center where we were greeted by 4 colorful flags with the words LDP+. And then there was Dr. David and Filipine who is in charge of the dispensary (called a dispensatrice here). The health center was plastered with enormous challenge models, including a stamp and the signature of the doctor at the bottom to show these were serious documents.  Dr. David had focused his challenge model on DTCHib vaccinations (= Diphtheria, Tetanus, Pertussis (whooping cough) and Haemophilus influenzae type b) moving the rate from 45% of the village children to 75%. He did better than that, and covered 96% and has ambitions to go to 100%.

He told us his vision for the center (which by the way has a good reputation even in the town across the river from where we had started): CSB2 Vert (Basic Health Center type 2 Green).  He had started moving towards that vision by planting fruit trees and flowers. The fruit trees each had an LDP+ flag attached to their protective reed mats.

We interviewed him outside and he talked about how he had mobilized the community, got a traditional agreement (called a “dina”) with the local authorities that would require parents of non-vaccinated children to pay a fine. He organized a team of traditional midwives, created an LDP+ football team and got the president of the village council to help spread the word about vaccinations. He obtained a fridge from the district health office by asking for one rather than complaining (“I now ask, in written form, rather than complaining”)

And once again we asked about personal transformations and he cited his changed relationship with his daughter (who was there to witness). The dispensatrice also told us she had changed and was less strict with the villagers when they had done something wrong, like not protecting their vaccination booklets against the rain (it rains a lot there). Now they are doing this even if is not strict with them. She made them understand. The booklets are now kept in plastic envelops.

Inside his office there was another art piece with the letters LDP+ and the text of a song he composed next to it. He and his daughter sung it for us. I recorded it and took a picture of the Malagasy text which I will get translated. It was lovely. He had also made a raffia weaving for me as a gift with LDP+ woven into the mat above the name of his village.

By the way, the toilets were spotless – a rarity in these places.