There are a handful of regions in Madagascar that hold an alluring mystique. Whether it is because these places are isolated in the deep countryside, tucked away off distant coastlines, or nearly impossible to reach by conventional means. The Sud Est (South East) is one of those regions. In my mind, it is an untamed and legendary place down on the eastern coast of the country. The Volunteers in that area exhibit a cultish loyalty to all things Sud Est and are extremely proud to call it their home. They shamelessly uphold traditions from Volunteers that served in the area generations ago, which is part of why it feels so different than other regions. It’s a part of Madagascar that I’ve wanted to visit for a while, but it takes some real dedication to make the arduous journey. Passing through a wide range of landscapes and enduring hundreds of kilometers of open road, anyone with a healthy sense of curiosity and ample amounts of patience can put their travel skills to the test with a visit to the Sud Est.
As luck would have it, one of our Peace Corps Medical Officers recently invited me to accompany her on a trip to this fabled land. The purpose of the mission was to visit health care facilities in the region in order to asses what medical services are available (or more accurately, what isn’t available) and to update contact information for physicians and clinics. We visited some current Volunteers along the route and got a taste of the mystifying Sud Est culture. Through this visit, I learned a lot about healthcare in Madagascar, enjoyed the beautifully diverse scenery of the area, and gained a better appreciation for the hard work that our Volunteers are focused on.
The statistics of the trip are telling of our work. During five days, we covered more than 723 kilometers (450 miles) roundtrip from Fianarantsoa headed east toward Mananjary, then south to Manakara and Farafangana, and all the way back to Fianarantsoa. Our team visited 11 healthcare facilities including rural outpatient clinics, private Catholic hospitals, and large government hospitals. This allowed us to see a varying range of care levels and meet with a number of dedicated doctors and nurses. We also got to see 11 Volunteers in their communities, which was a special look into the realities that they live in every day.
Covering as much ground as we did gave us the opportunity to see many stunning terrains. From the onset, the road from Fianarantsoa glides through the highlands countryside, with sprawling rice paddies laying at the base of formidable rocky mountains. As we approached Ranomafana, the scenery changed to steep hillsides covered in thick rainforest. There were quite a few landslide areas along the road leftover from Cyclone Enawo and the subsequent heavy rains. Continuing down the windy road to the east, we passed the Vatovavy mountain. This gorgeous massif is part of the region’s namesake, Vatovavy-Fitovinany (Female Rock-Seven Estuaries). From Mananjary south through Manakara and further on to Farafangana, the road mostly runs parallel to the coastline and offers occasional views of the Indian Ocean. On the more inland portions of road, the landscape is a mixture of heavily deforested hillsides, scrublands, gorgeous rolling hills covered in nothing but soft grass, pine trees, and iconic Malagasy Ravenala.
While visiting the various healthcare facilities, there were some noticeable differences between private clinics and government posts. For the most part, the private establishments were funded by religious organizations that could provide a much more robust source of income compared to the government. This is where we saw the more advanced medical equipment, the larger laboratories, the most patients, and the proper amount of staff to make it all work. The government buildings were more likely to be in a disheveled state, the equipment was more likely to be out of date, and the facilities sometimes lacked qualified personnel to offer specialized care. Another aspect that I noticed across the board was the fact that despite a tremendous number of patients and their families coming to the facilities, none of the hospital staff seemed to be in any particular rush. I don’t mean to say they were being lazy or inconsiderate to the patients, but they all appeared to have a calm and methodical focus to providing compassionate care. The doctors that we met humbly took us on tours of the clinics and proudly showed off whatever equipment and laboratory space was available.
For me, the most rewarding aspect of this whole trip was the chance to visit other Volunteers in their communities. Every site where a Volunteer lives and works is unique, so seeing these locations first hand allows me to better support Volunteers and advocate at the administrative level on their behalf. During the five days of travel, we met with Volunteers from all three project sectors (Health, Education, and Agriculture), saw almost all of their houses, met many of their friends and work counterparts, and learned a great deal about their experiences. I was impressed by how tamana (settled, well adjusted) these Volunteers are and how well integrated into the community they have become. The Malagasy work partners that we met all had great things to say about their Volunteers and they were so delighted to talk about the positive outcomes of working with an American. In one particular village, the timing of our visit happened to coincide with an official opening ceremony of a clean water project that a Volunteer had been working on. We attended most of the ceremony, witnessed a government official conduct a ribbon cutting, and celebrated the culmination of a fantastic community collaboration.
No matter where we visited, it was obvious how each Volunteer has become a real part of the village family and how their Malagasy peers have gone the extra mile to make their American neighbor feel right at home. Further proof that if you are willing, Madagascar can steal your heart.