It’s been a month since my last update, and there is so much I could tell you about, it’s difficult to decide what to write about. I spent 3 weeks back in Betafo (the rural area I stayed in for a week in March) doing field work for my independent study project, and then this last week I spent back in Tana (the capital) writing up my findings. Although I presented my project last Friday, the paper is still on my mind since I still have some editing to do, so I think I’ll use this blog post to give you an overview of what doing the project was actually like.
In the beginning it was difficult to explain to my host family that I was there to do an academic project, not just on vacation. The previous time I stayed with them I had absolutely nothing I needed to get done, and never went anywhere alone, so this time, when I told my host dad, in broken Malagasy, that I wanted to go into town by myself to talk to doctors, it caused much confusion. None the less, he did let me go, and after a few days my family got used to my new schedule. Most mornings I would walk into town and spend a few hours at the CSB (Centre de Santé de Base, i.e. basic medical clinic) or district hospital, observing and chatting with the doctors and midwives. When consultations ended around noon, I’d head home for lunch, and spend the afternoons writing down what I’d learned and interviewing residents and local government officials. My time in the clinic/hospital was pretty much the same as shadowing doctors the way I’ve done in the US and South Africa in preparation for med school, except that in Madagascar gaining access to do so was much easier. I could literally just walk into the dentistry, or maternity, or laboratory, or any other section of the hospital, explain to the person working in that department that I was a student doing a project related to public health, and be allowed to stay and watch everything going on. The staff was really friendly and helpful, and in fact, the doctors at the clinic were quite ready to let me take part in examinations and even administer injections. Although I was tempted to try, you’ll be relieved to hear that I refrained! In the US it’s very much taboo to perform procedures like injections without training.
The project culminated in a 40 page paper, so I couldn’t possibly share with you everything I learned in this post, but I will say it was fascinating to see how the practice of medicine changes based on the resources available and the local context in general. For example, in Betafo there is a program for malnourished children. Community agents identify at risk children (0-5yrs) on a neighborhood level, and send them to the CSB on Tuesday morning. At the clinic they measure the height, weight, and circumference of the arm of the child, and based on these measurements determine if the child is undernourished or not. If he/she is, the parent is given enough “plumpy nut” specially formulated food to supplement the child’s food for a week, and told to return every Tuesday for a check up until the child is better. All this is completely free, and for this reason the parents have to bring back the empty plumpy nut packages each week to prove that the food wasn’t sold but rather consumed by the child. What an interesting contrast with the US, where the focus is on preventing obesity, not undernourishment!