Health in Anosy- what’s the situation?

So what actually am I actually in Madagascar for?

Me outside the SEED office, as you can see it was raining!

Well after two weeks here I can finally fill you in. I feel like I’ve got to grips with the two projects I am working on after a lot of reading, and a couple of trips to the field which really put everything into context. More and more I’m seeing how the Anosy region is different to other places I’ve been in Madagascar, and why it is in need of some serious attention. Geographically Anosy is cut off from other regions by a large mountain range with terrible roads that are impassable for many, in fact the name “Anosy” actually means island in Malagasy (Anosy is coastal but by no means an island). In terms of how that affects the people here; the state of their health system is reflective of Anosy’s isolation. The hospital in Fort Dauphin is one of only two hospitals serving an area of 26,000 square kilometres, with an estimated population which is double that of London. The rural areas known here as the bush, only have small health centres that are currently experiencing stock outs (more on that later), and outreach to communities outside of villages is done by volunteer government agents called “agents communitaire” or ACs.

Just around the corner is the hospital in Fort Dauphin. I particularly loved this sunset.

So how can anyone make a difference in this place?

This is a question that has crossed my mind once or twice since arriving, how can a place with a high poverty index, lack of resources and a lot a systemic issues change? One of the great things about SEED is how the projects are tailored to the big problems here- based on a comprehensive situational analysis. The two projects I’m working on target knowledge and practices, two things that actually can be changed for the better and are within reach. I guess the learning point here is that sometimes it is better to put your efforts into something feasible and that has impact- rather than come in guns blazing and try to “correct” the system. Which is where a lot of organisations might fail. So, what are these projects….

Project Votsira– The term “Votsira” means a state of well-being for a mother and her child in Malagasy. That sums up what the project does; education for mothers and caregivers about maternal and child health on topics such as breastfeeding, nutrition and early childhood diseases. It’s one of SEED’s longest running programmes and has reached over 2750 caregivers. Malaria, acute respiratory infections (ARIs) and diarrhea are the mai causes of death for under 5’s in this region. All three can be treated or prevented, but a lack of understanding about the symptoms and a deeply-rooted culture of seeking traditional healing means that children aren’t seen by doctor.

The caregivers at the Votsira beneficiary group.

Over the course of the past year, CLOs (community liason officers), which are Malagasy national staff trained by SEED, have conducted beneficiary sessions for mothers and grandmothers with Votsira’s child health course. The sessions were held in communities in areas of Fort Dauphin and included practical demonstrations and advice as well as some great educational posters to take home. I was lucky enough to attend a follow up to these sessions in which the beneficiaries reflected on their learning and the project. It was amazing to see so many women in attendance with their children, and the passion they had for bettering their community. I also got the chance to get my hands on a proper camera (I’ve always thought my iPhone wasn’t bad) and take some photos which I really enjoyed.

A child from the Votsira focus group with the poster. (Pretty proud of this one my first go with a decent camera!)

Project Mitao– Mitao means “to protect yourself” in Malagasy and is an analysis of sexual and reproductive health provision, practices and knowledge across rural and urban areas of the Anosy region. This has consisted of interviews, surveys across large population groups and also monthly roundtable meetings with local stakeholders such as the chief of commune, headteacher of the local high school and health centre staff. Mitao is in a really busy phase with lots of data being collected right now, and I was lucky enough to go to a place called Mahatalaky for the roundtable meeting this week. The two hour ride in the 4×4 was adventurous to say the least, the roads are thick with mud and potholes and I can absolutely see why people from the bush might not want to make the 2-3 hour journey to Fort Dauphin for treatment in a big overcrowded truck.

It was very interesting to hear the different opinions from the attendees on their solutions to the rising STI and HIV crisis in rural Anosy. One of SEEDs main goals is to increase the capacity of national staff and local people to deal with problems arising in their areas. This is something I really like about the NGO, like training Malagasy staff to conduct meeting and focus groups- and therefore getting much more honest, actionable and satisfying results from the projects. In the long term the hope is that these people will be experts in their field and SEED can lay the foundations for progress, and improving healthcare here without taking over.

The centre of Mahatalaky which is in the rural bush area of Anosy. This was the site for the Mitao roundtable.

The next section of project Mitao is a survey for sex workers and men who have sex with men (MSM), both vulnerable groups in this area, especially with this steady rise in HIV cases in Fort Dauphin. I was shocked to hear that some of the sex workers may be girls just 12 or 13 years old. As part of the survey, these people would get a free HIV test. However, it was discovered that there has not been any reactive for the test in Anosy for some time now, and subsequently that the whole country is stocked-out of HIV tests. It is hard to know that the project is aiming to educate people and encourage them to get tested but that the situation here just doesn’t allow that sometimes. This was definitely a blow to the project, but in a way has brought to attention this issue of supply and I am hoping that some tests will be brought in in the coming weeks! This is just one example of why Madagascar needs capacity building and expertise.

I have already learned so much in the past two weeks and am very excited to continue work on these projects! If you’re interested in what SEED do in community health or in their other projects take a look at the website. https://madagascar.co.uk/projects/community-health

The electricity has been down for nearly 48 hours now in my neighbourhood so I’m currently writing from a hotel café- thanks to the rain and wind I think it will be a while before it gets going again but until then thanks for reading.