“AR MADA” — Aller-Retour Madagascar

It’s 30° Celsius in the shade at 6:30 a.m. Despite the early hour, a crowd of people from all over the region are already waiting for the AR MADA doctors in Begidro, a village in the western part of Madagascar. The people waiting there in the heat suffer from open wounds, skin abscesses, and intense toothaches. The medical team treats 368 individuals in just two days. From Begidro, the team moves on to Betomba, where it treats 119 patients, and to Tsaraotana, where the team takes care of 470 people. The accompanying dentist pulls a total of 225 teeth. The team’s dermatologists, surgeons, general practitioners, nurses, and helpers set up their offices in village schools.

 
Marielle Berthier, who works as a marketing assistant at Merck Médication Familiale (MMF) in France, distributes medicines and explains how much of each drug is needed and how it must be taken. She tells patients what powder they have to take with how much water, and how often a baby should be given a medicinal syrup. Miss Berthier is accompanied by a doctor and an interpreter. “There’s a general scarcity of clean water,” says Miss Berthier. Poverty, malnutrition, and insufficient hygiene cause chronic diseases. Skin and eye infections are common, as are malformed children. Eel-worms, nematodes, and ticks cause severe infectious diseases. Nobody here can afford treatment, but everyone hopes to get help.

A boat crew that is familiar with the region takes the doctors and their big metal box full of medicines in a wooden boat from village to village, traveling along a river that has far too little water this year. “Again and again, somebody has to get out of the boat to prevent it from running aground on a sandbank,” says Miss Berthier. In the afternoon, the thermometer rises to 45° Celsius along the Tsiribihina River. “Many patients have walked for hours to get here,” Miss Berthier adds. People frequently have to walk ten kilometers to reach the next treatment station, thus increasing the frequency of chronic illnesses and emergencies. AR MADA brings medical assistance to regions that are difficult to reach and cut off from normal healthcare services.

“The disparities on the island are obvious,” says Miss Berthier. Whereas the capital of Antananarivo is literally choking on car fumes, the people in the rural areas walk or hitch a zebu to their carts. Not even 15 percent of the island’s roads and paths are paved. The other roads are gravel tracks that become impassable when it rains.

Medicines are scarce, and the rural healthcare centers lack antibiotics and painkillers, as well as preparations for combating diarrhea-induced salt loss. Although these centers have nurses and midwives, they often lack a doctor; nonetheless, they form the backbone of the public healthcare system. The Centres de Santé de Base I and II (see box) provide vaccinations, prenatal care, and help with births that do not involve complications. There are no specialists among the doctors in the district hospitals, which lack even simple analytical tools such as test strips. What’s more, X-ray machines and ECG devices are either nonexistent or outdated. The staff is trained with help from abroad. Hygiene items and food are lacking, and the mortality rate in the hospitals is high. Although a total of six well-equipped university hospitals can be found in the capital of Antananarivo and some other major cities, most people on the island cannot reach them.

As a result, the number of patients the AR MADA team has to treat is steadily growing. The team’s doctors have treated more than 100,000 patients since January 2000. AR MADA is a nonprofit organization that has sent out nine humanitarian missions annually since it was established in 1999. Each mission lasts two weeks. “We have conducted more than 60 local trips with 900 doctors and nurses,” says Dr. Christian Gros, co-founder and director of the organization.