Adventures In Madagascar

Anna Christine's Story

Mbôlatsara!

Here's a story about Anna Christine, a midwifery student from Denmark who was working with a Red Cross midwife here in Diego Suarez , Madagascar at the dispensary. From her stories it's a very different world. The medical equipment and the mindset are from the 1950's. Sanitation as we know it doesn't exist.

Anna Christine's first day at the dispensary:
She walks into the side door and it's dark because electricity only is on from 10p.m. to 4a.m., it's 8 p.m. and all the doctors have left for the day (emergencies are sent to the "Big Hospital", sent by foot. The big hospital is 1½ miles away over roads that are little more than dry dirt with rocks thrown in the numerous holes. There are 2 midwives and one guy who serves as a janito. The hallways are filthy with trash and the smell of old urine. She is greeted by one of the midwives with a candle, they talk (in French) in the very small triage room which doubles as a broom closet and the pharmacy. A very obviously laboring 15 year old girl comes into the "waiting room" accompanied by her sister or possibly her mom (Anna Christine was not sure because she doesn't speak Malagasy and the midwife speaks broken French).

The midwife brings the laboring mom into the triage room and weighs her on a scale that is older than everyone in the room added together, the weight is wrong so the midwife guesses, takes her temperature, Blood Pressure, pulse, and sends her down one of the dark hallways to a dark room. The 15 year-old must bring all of her own supplies; candle, matches, alcohol, gloves, bar of soap, needles, string, scissors, rags or towels as well as $7.50 fee for the delivery (the average Malagasy makes a little under $1 per day if they have a good job). Then the midwife tells the girl to get up on the table (which is a wooden board with a thin foam pad covered with plastic), and says to call her when she feels like pushing. That's not the end of Anna Christine's story. In a couple of hours the lights come on and the walls are covered with mosquitoes and flies. She also sees why the air smells like urine. At this point Anna Christine said she wanted to go home. Moments later the girl's sister comes walking down the hall to tell them she is ready to push. They arrive in the room and the young mom-to-be is still on the table knees up and lying on her back, in front of the table is a puddle of blood about a meter in diameter, the midwife hollers down the hall for the janitor, he comes in and takes an already blood soaked rag from his collection and smears the blood around on the floor. The birthing mom is nearly naked on the table ready to push and crying because the midwife is scolding her for groaning too loud. After about an hour of pushing the mom is exhausted but gives birth to a boy. One hour later she and all of her stuff must be gone, little to no clean up is done afterwards by anyone, if the next mom wants it cleaned up she or her sister will have to do it. Anna Christine said that there are so many blood circles on the floors it's almost awash with it.

There are no toilets. Outside there is a hole in the ground surrounded by some dry brown grass. Water comes into the building—they have it from about 9a.m. to about 3p.m., it varies. There is no hot water at all, the only disinfectant is what the mom brings and that is a bar of soap and, if she can afford it, some alcohol. Usually delivery is the first time that the mom has ever been seen. The mom labors somewhere else; could be home, at the market if she is a vendor, in the field if she works in the rice field or...use your imagination. It is "fady" for a woman to make any noise while in labor. "Fady" are man-made taboos, very effective in controlling behavior.

That's just one of Anna Christine's stories. She says she works 3 nights a week and 4 days a week, she gets no time off. She said she thought that the international Red Cross was supposed to keep and eye on all their clinics. It turns out that one of the inspectors did come but only stood outside the building and then left. She was even introduced to him but he didn't go in.

You may be asking, "Why doesn't the mom just stay at home?" Their houses are made of narrow planks of wood or split bamboo with openings in between and the floors are covered with dust blown from the wind; flies, mosquitoes, cockroaches, all kinds of diseases. But it's also a status symbol to have your baby at the hospital or dispensary because it costs money. If you have that kind of money to "blow" on a baby you're rich like the vahaza (white foreigner). In my eyes there is no difference between the two places, but that is coming from a vahaza point of view.

Take care. Valoma, Samitsara.
God's Peace,
Deborah

Malagasy word(s) of the month:
Karibo amin'y Charis. (Welcome to Charis.)

Baies des Dunes

Second largest bay in the world after Rio de Janeiro.  These
are two of the bays  that rest side by side in Diego Suarez.  There are two others and the four massive bodies of water all form one big bay.

Dernière baie Avant

Village in Diego Suarez

Diego Suarez Market

Malagasy Children

Missions Trip to Madagascar Reminder

Since the Hamiltons will be traveling back to the US this fall and winter, we have changed our trip date to July of 2008. We are going first and foremost to be a blessing to the Hamiltons. While there, we hope to put on one or more "workshops" for the midwives and other medical professionals in and around Diego. In addition, we would like to bless the medical professionals with a gift that will help them in their practice. Please pray for David, Deborah, and Kristin as they seek God's direction for the specific topics to address in the workshop(s). Also pray to see whether or not God would have you join us on this adventure. It will, no doubt, change your life as you go to serve the Hamiltons and the Malagasy people. We will have the official "sign-up" at the beginning of 2008. More details to come.

David, Deborah, MarLee and Liam Hamilton

 

Tidbits from EBONY

Birth In Ebony

Dear Charis Friends,

Imagine a building with electricity that comes and goes, dirty water backed up in sinks, unsanitary latrine facilities and the smell of bleach burning the nostrils of the visitors.  That is what Ebony hospitals and clinics seem like to me.  Of course, each one is different.  In the city of Candybar, (the city in Ebony where I reside), local people say the hospital is not a place where you go to be healed, it is the place you go to die.  People must bring their own supplies for any procedure at the hospital.  For a C-section, women bring their own string for knitting wounds, their own IV equipment bought at a dirty bazaar downtown, etc....  Really, there are very few of the amenities we think of at the hospital.  It is also said in Candybar that, if a woman must have a C-section as a last resort, she will go to the hospital and the doctor will say to the family, “Which one do you want me to let live—the mother or the baby?”  It is assumed that both would not make it out alive.  When I have visited hospitals in Ebony, they have been packed with people who receive very little care for their conditions.  The most effective care occurs in small clinics which are not government funded and which are located throughout communities.  These kinds of clinics often treat problems that were incurred originally at the hospitals.  There is one hospital in Ebony that I know of that has adequate healthcare for most situations—including those related to pregnancy and childbirth.  This hospital is located in the capital city of the country, however, and is logistically inaccessible to the women of Southern Ebony.   So most babies are not born in the hospitals or clinics there.

When a woman is ready to give birth, she usually states that  she is not feeling well and will then retire to a private room in the home.  Every family is different, just like in our culture in the West.  Sometimes a mother-in-law or sister attends the birth and helps with pain management, spiritual issues, and care for the newborn.  Often (about 50% of the time or more) a woman is expected to deliver alone.  There is a saying in Candybar that when a woman goes into labor, she goes into the closet and shuts the door and she either comes out or she doesn’t.  Among the nomadic peoples, women are especially shy and view their bodies, and the birth process, as shameful and dirty.  They will deliver their babies along the road or in a field while their tribe travels on ahead of them.  I have been told that, after some hours, the father of the baby will send a donkey back for mother and child to ride on until they catch up. 

If you were to ask a family in Ebony if Father’s attend births, they would say “No” every time.  But, I have heard stories from men who became involved when an emergency occurred.  One such situation was when a mother began hemorrhaging during labor.  The father did not know what to do, so he tied her onto a board or mattress and positioned it against the wall so that she was hanging upside down.  There is an extreme need for education among both men and women in Ebony about basic principles of health, hygiene, first aide, prevention, etc....  Fathers generally are not interested in learning about women’s health or supporting initiatives within the community focused on this subject.  But, a movement has begun in the Northern part of the country among men who are realizing that it is possible to prevent the deaths of their babies and wives.  They are becoming more interested and knowledgeable.  They may never reach the point where they consider it acceptable to attend births, but I pray that in our lifetime they will begin to participate in protecting and saving the lives of the women and children of their families and their country. 

Prenatal care is virtually non-existent.  It consists of women being given instructions from their mother-in-law or some other older woman.  Sometimes this information can be right and helpful, but many times they simply receive false information and training in how to ward off evil spirits which are viewed as the cause of all health problems.  Prenatal care is one of the keys to changing the infant and maternal mortality rates in Ebony and it is becoming one of my passions! 

It seems that during labor and delivery many things come naturally to the women of Ebony—positions, noise making, etc....  After birth, babies are sometimes allowed to root and nurse.  They are kept close to their mothers.  They are held and loved on and sleep with their mothers for up to forty days of rest.  One of the most important aspects of infant care in Ebony is to dedicate the baby, at birth, to the religion of Islam.  The faith confession of Islam is whispered into the baby’s ear by his/her father or a religious leader VERY soon following birth.  I believe this is a spiritual stronghold of the region and am honored that some day I may have the opportunity to pray protection and dedication to the One, True God before this Islamic ritual occurs in their young life.  There are many misconceptions surrounding infant care in Ebony.  One that is heavy on my heart is the myth among women that colostrum is “sour milk.”  They view it as milk that is nine months old.  Some women let their babies nurse anyhow, but others are known to starve their babies for the first few days until milk comes in.  Sometimes, they start them off with formula that has been donated as a free gift to the family.  The family does not have money to buy more formula so, in order to make it last longer, they water it down until their is virtually no nutritional value at all.  Often, formula is mixed with dirty water, so babies end up dying of dysentery before they die of malnutrition.  I am sorry to seem so gloomy here, but with the highest infant mortality rate in the world, there is very little uplifting news to offer. 

There are differences in the areas of Ebony.  As you would expect, the further away from an urban area and the less financially affluent the family, the more deaths occur.  The sad thing is, whether in the city or in rural areas, many of these deaths are preventable.  My passion is to spend the next several years learning more about this land and people and teaching local women to train others themselves in principles of prenatal and infant care so that they can have some hope and success in childbirth. 

Well, I hope my uplifting and succinct lecture here has just caused all of you to feel called to come work with me in Candybar!!!  :-)  I won’t object!!!  :-)  In all seriousness, please, please continue to pray for the situation in Central Asia—that, by the mighty hand and mercy of God, hope and life would be brought to the women under the veil.

All my love,

Elizabeth Carmichael

Children in Ebony

Keeping warm ... Ebony refugee children gather around a fire at a refugee camp. Ebony is one of the world's poorest places, ranking 173 out of 178 countries, a development survey said.
 

Many Ebony children have moved to refugee camps because their homes have been destroyed.
 

A group of Ebony children.
Although education is valued in Ebony, only 5 percent of Ebonian children receive a primary education.
 

Children in Ebony

Children waiting to be seen at a clinic in Ebony