Fieldset
Malnutrition in Madagascar: Progress

Nurse Benjamin and the team do their first return trip to a village caught up in Madagascar's nutritional crisis...

Women help build the shade nets for the clinic

Long 4x4 trips have taught me at least two things. First, you should close your window when crossing a muddy pool. Next, it is important to bring headphones or earplugs, the zouk and music of Celine Dion having obviously spread across the planet like the coronavirus.

Back at base

Once back at base, after a mobile clinic, members of the medical team have the luxuries of running water, sluggish wifi and homemade rum. The weekend is a marathon during which you have to give news to your loved ones between meetings and quantified reports, without forgetting to purchase the equipment and food you need to set out again two days later.

Two international staff - a doctor and our medical coordinator - have just left our small Spanish hostel, returning to Europe due to family concerns. In exchange, we welcomed a coordinator and a French water and sanitation specialist, an Austrian doctor, a Quebec nurse and a Swiss communications officer. In the eyes of these newcomers, I figure among the old ones, with my 15 days on the project and my cyclist’s tan. Anyway, the inflation in the number of international staff and the increase in the fleet of our HQ can only indicate one thing: the situation is serious enough for MSF to stay put.

The next clinic

After an episode of rains during the weekend, it is already time to leave for the next clinic. The roads turned out to be degraded but all in all passable. In the ponds that border the track, our convoy turns the heads of the Madagascans busy bathing alongside the thirsty zebus.

These people have known hunger for at least two generations and yet demonstrate extraordinary courage and resilience

Our first stop and undoubtedly the highlight of the week is Ankamena, a small fokontany (village) we visited two weeks ago during our very first mobile clinic.

In this village at the foot of its mountain, the residents emerge from their homes when they hear the sound of the engines. Here, the food crisis means that people rely on the World Food Programme distributions.

Faced with this umpteenth community living on a drip, the inevitable question arises in my mind - what is the future that is promised to people here when, in six months, a year or more, the acute crisis is over and humanitarians will have left the place?

Courage and resilience

I observe the mountain and the vegetation that covers its sides. It is reassuring to know that in some places it is still possible to admire landscapes without human construction. Will the people here hold on to this land where their ancestors rest, as they always have?

These few hundred grams gained from malnutrition are an encouragement to continue our efforts and confirmation that they will bear fruit

These people have known hunger for at least two generations and undoubtedly much more, and yet demonstrate extraordinary courage and resilience, like this teenager of about fifteen carrying on his back his disabled younger brother to take him to our distribution. He will leave loaded with a few extra pounds of plumpy’nut, a therapeutic food.

Pleasure and disbelief

The kids hang out in the shade of trees and houses, mocking my French accent while nibbling on locusts to stave off their hunger and boredom. One of them is playing music on a sort of homemade ukulele with three nylon strings. I take a picture of the artist and almost start a riot of excitement by showing the kids the pictures on the LCD screen of my SLR.

This is our first follow-up visit to Ankamena and we are seeing the children we included in the programme two weeks earlier. We measure with pleasure and sometimes disbelief the progress they have made. Most have gained weight. These few hundred grams gained back from malnutrition are an encouragement to continue our efforts and confirmation that they will bear fruit.

Water

The rest of the week, we have a series of site openings in three remote villages: Kapila, Ambovo and Ambatomena. In this latest fokontany, I ask a woman about the state of crops. She explains to me that the rice fields lack water, that the maize is eaten up by locusts and that they don't have the seeds to plant beans. Their main hope now lies in the approaching sweet potato harvest. She hopes that the village will not be visited by the dahalos (cattle thieves) and plundered of all its resources.

In total, we register and treat more than 300 new patients in four days

In the waiting area of our clinic, a child barely three years old tears shreds flesh from a raw goat's leg. On the mat is a plastic bottle filled with opaque water. I learn that the inhabitants of the hamlet –  at least the women and children to whom this task is devolved – usually go to fetch water from the river, located two hours’ walk away. The latter being dry, they must now dig the bed of the stream or simply collect water from the ponds. Not surprisingly, the prevalence of bilharzia and intestinal parasites is very high. Many people tell us that they urinate blood.

Incredulous

The day goes by to the rhythm of admissions and bags of plumpy’nut that the women carry on their heads. Our measurers, recorders, doctors and nurses are all absorbed in their work. A woman brings a baby to Fanny, one of our team. This is a two-month-old baby girl whose mother died in childbirth. The caregiver turns out to be the baby's grandmother and cannot breastfeed enough. Obviously, no other mother in the village has agreed to welcome an additional mouth into her home.

Gicoh, a nutritional assistant on my team, wonders:
- Do you have malnourished children in France?
- "Sometimes they are over-nourished," I told him. “We have adverts which encourage them to eat less and play sports.”

He laughs, incredulous.

Frustrations

In total, we register and treat more than 300 new patients in four days.

We remain frustrated at not being able to treat sick adults, we lack time and especially resources to treat everyone. The doctors are particularly troubled at not being able to provide their tuberculosis patients with a specific treatment which exists but is only available in cities, i.e. more than five hours of walking and then the same again in a bush taxi. For these patients, a consultation in the city might as well be on Mars.

And for those, if any, who will make the trip anyway, one can hardly imagine the risk of transmission if they travel in an overloaded taxi-be (the elderly minibuses which provide public transport in Madagascar).

The week goes by

The team that I supervise is now autonomous. At the end of the day, when the crowds decrease, I sometimes have the opportunity to slip away for a few minutes to stroll around the site. The week goes by in morning awakenings, hot working days and light dinners, followed for me by a writing session by the glow of my headlamp.

The coordination team is starting to think about setting up a hospital structure that will accommodate children requiring close care and supervision. As for us, the mobile clinic team who have recently returned to the Ambovombe base, we will not bother to empty our backpacks because we will have to leave tomorrow for another week in the bush.

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Top image: The women of Ambatomena lend us a hand in weaving a net of leaves to create shade for people to wait in.

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This post is part of a series. You can read the first post here. To see all the posts, click here.