In February, cyclones Batsirai and Emnati reached the east coast of Madagascar weeks apart, destroying many health centers and affecting more than 150,000 people. In response, emergency teams from the international medical humanitarian organization Médecins Sans Frontières (MSF) are providing care to people in the isolated rural areas most affected by the damage.
Providing services in places where access to health care and other essential services is limited is essential but difficult work. It takes nearly two hours for the MSF emergency team to cover the 20 km [20 kilometers] which separate the town of Mananjary, where MSF has been based since Cyclone Batsirai, from the village of Mahatsara Lefaka. There, the roof of the health center was torn off as well as the solar panels that provided its electricity.
“Before the cyclones and the destruction of the health center, there were consultations every day here,” said Nicole Vololoniaina, a midwife who has worked at the Mahatsara Lefaka health center for 18 months. “Today is the first time I’ve been back in three weeks.”
That day, she accompanies the MSF team which provides consultations to the many inhabitants who have come to the village school, where she runs a mobile clinic. For nearly a month, most people here have had no access to health care.
Among the 37 people seen that day was a nine-month-old child who had an infected abscess. His leg was injured in two places and, without antibiotics, he was at risk of septic shock. The child and his parents were taken by the MSF team to Sainte-Anne hospital in Mananjary, where he was admitted for treatment.
“The abscess is a complication of the original wound,” said Dr Johnson Heritiana, who works with MSF. “His condition deteriorated because he could not benefit from any treatment. His parents took him to a pharmacy in Mananjary where they paid for three doses of antibiotics. The treatment was insufficient, but after the cyclone they priority was to rebuild the roof of their house and to find water and food.They cannot afford new medical treatment.
Lack of housing exacerbates disease
Most of those affected by this most recent cyclone had managed to repair their homes after Cyclone Batsirai, but building materials are scarce and expensive, making it prohibitively expensive to rebuild homes a second time.
“Many people were injured during the first cyclone by the wood and the sheets torn off by the wind”, continues Vololoniaina. “People who had no shelter got sick, they were coughing and we saw that people also had diarrhea because they were drinking polluted water from the river.”
The team also treated people suffering from respiratory infections, malaria and chronic illnesses. “Of 19 people tested, 11 were positive for malaria – and those were just the people who had symptoms,” explained Dr Johnson Heritiana. “This is the season when we normally see a peak in malaria, but the pools of stagnant water that accumulated after the cyclones made the situation worse.”
Care of patients in precarious situations
In the district of Mananjary, access to water, food and other essential services was already difficult even before these two cyclones.
“We have identified around 20 malnourished children in the village,” said Vololoniaina, the midwife. “As the treatment is not available in our health center, we have to refer them to Mananjary. It takes more than three hours to walk into town, and many people don’t go there because they think they will have to pay for treatment.
Limited access to healthcare has always been a problem in the area, but the destruction of the health center and damage to the main road further isolates the residents of Mahatsara Lefaka. Many non-governmental organizations find it difficult to get there and have to use all available means of transport, from walking to canoes, to get there and assess people’s needs.
Other even more remote areas are more deprived of humanitarian assistance and telecommunications are still not available in many places. MSF teams have carried out more than 250 consultations in rural areas of Mananjary district since the start of our intervention. This is in addition to more than 100 consultations a day in tents set up by MSF at the public hospital in Mananjary, destroyed by Cyclone Batsirai.