Madagascar

I spent two weeks in Madagascar as part of a joint CDC/USAID team on an assessment visit to help us get start figuringo ut how to spend the money the President's Malaria Initiative has allotted to Madagascar. There are 4 major interventions supported by PMI: indoor residual spraying of insecticide, insecticide-treated nets, treatment of cases with artemisinin-based combination therapy, and prevention of malaria during pregnancy. Our job was essentially to meet with the national malaria control program and all the organizations already doing malaria work in Madagascar (WHO, UNICEF, PSI, CARE Iinternational, etc) to figure out who was doing what and what the gaps are, especially as far as funding is concerned. The first three days were meetings all day that were grueling, but just fascinating. It was a lot of fun to meet with the various groups and find out what people are doing.
Antananarivo is the capital of Madagascar, and is in the center of the country on hills on a high plateau. It's relatively cool, and looks very European. This was the view from our hotel, which was one of the most elegant places I've stayed in - even had a very nice spa and gym! There is a lot of French influence, and consequently a lot of incredible French restaurants. We ate ridiculously well - foie gras, duck, escargots, filets, creme brulee...After three days of meetings and workshops, we split into three groups to do site visits. I went to Mahajanga, on the northwest coast. We visited health facilities at all levels from university hospital to community health center. This is the team in front of one of the community health centers. Learing how things are actually working (or not working) at that level is key!

Our team had a great time together, too. We very much enjoyed going out to eat in the evening and laughed uproariously most of the time! Below are several members of the national malaria control program, as well as representatives from USAID, Basics, SanteNet,WHO, UNICEF, and PSI.

Malagasy (people from Madagascar) are descended from Indonesian peoples who settled here from across the Indian Ocean centuries (maybe millenia) ago. They look very south-east Asian, and the language and culture are also more Asian than African in many ways. (The darkest-skinned person in this picture is actually a guy from Cameroon working with one of the American NGOs!)
A scene from Mahajanga. Though there are taxis, the most common way that people get around is still the rickshaw. It's so hot that sweat pours down you while sitting in the shade, and these guys literally run these little rickshaws around with several people in them! It was mind-boggling. There's so much deforestation in Madagascar that the ocean is red with silt where the large rivers run into the sea.

Sunset over the Mozambique channel, from our hotel. The hotel was called "La Piscine", or the swimming pool - they have a 50 meter pool! It's tiring just to do one lap!

The next week was back in Antananarivo writing our report and wrapping up meetings, before doing a briefing on our findings for the Ministry of Health and partners on our last day. I had volunteered to do the malaria in pregnancy and insecticide-treated net sections, and had my hands full.

I was hoping to have one day to get out to a national park and see some of Madagascar's wildlife in their natural environment. We ended up, as usual, working every single day. I did manage to get to the local zoo the morning before I left - so here's my lemur picture. :)