Our first stop in Madagascar – the capital city of Antananarivo!

Like I wrote about in our last post, our first stop in Madagascar was the capital city of Antananarivo, nicknamed “Tana”.  Tana is a city of ~1.5 million people, but is quickly growing because more and more people are moving from the countryside to Tana in search of safer living conditions.

The city itself is in the center of the island and, to be frank, is extremely crowded. The infrastructure was not built to hold the number of people, and especially cars, that are in the city, which leads to major congestion. At one point it took us two hours to make the 15km drive from our hotel to the airport!

We had been told by a number of sources to be cautious when walking around the city during the day, and to not walk around the city at night, because it isn’t safe. It was really interesting to see the stark difference between day and night in this city – during the day it was bustling with lots of people and so much energy.

But once it was dark the streets were desolate. Our hotel even had armed guards that had to walk with us if we wanted to go to dinner nearby (literally only 100m away). I know the crime is a result of the extreme poverty that so many people live in, but of course, it was still a bit unnerving.

Anyway, after recovering from jetlag we woke up on Monday morning ready to spend the day with the UNFPA’s Madagascar office. Here is a view of the street that our hotel was on, as seen in the early hours of the morning.

The drive to UNFPA’s office took close to an hour and it was so neat to watch the signs of everyday life in Tana go by our windows on the way. It was laundry day, so we saw lots of folks washing their clothes in the rivers and then drying them outside!

Our day in Antananarivo with the UNFPA’s Madagascar office

I first learned about and donated to the UNFPA (the UN Population Fund) in early 2017 and very quickly became more deeply involved with the organization. The UNFPA’s mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled, and especially in today’s global political climate I feel extremely passionate about the UNFPA’s work in promoting maternal health and family planning around the world.

I serve on the Development & Communications committee for the Friends of UNFPA (the UNFPA’s U.S. fundraising arm), and through some wonderful people there we had the opportunity to spend time with UNFPA Madagascar and see firsthand the impact the organization makes.

We had a full day of activities set up for is in Antananarivo, starting with a briefing at the UNFPA office. We learned about the organization’s focus, its impact and its needs. Here are some quick facts:

• 4,000 new fistulas occur in Madagascar each year, the UNFPA is able to fund the reparation of 1,000 of them (for comparison, only 58 fistula repairs happened in the country in 2012)
• In Madagascar’s poorest region (Androy) contraceptive usage has increased from 7% in 2012 to 14% in 2017
• Through the UNFPA’s advocacy, a new law was passed last year, allowing those who are under 18 to access family planning (e.g., contraceptive) services – before then it was illegal

So now let’s go into the field!

Stop 1: Centre for Women Vocational Training

This center was founded in 2016 and the goal of the center is to provide underserved women the training needed to create their own self-sufficient businesses. This is a critical service because only 64% of the population over the age of 15 is literate and 40% of girls aged 20-24 are already married with children. Education services are extremely limited (only 2.8% of GDP goes to education), especially in rural areas, where the local school can be over 40km away (an impossible distance to cover by foot every day).

~1,200 women have been trained since the center opened, some of whom are fistula patients post-repair (which is the cohort of students that the UNFPA supports). The women in the center are training in computer skills (they were learning how to do mail merge the day we were there!), sewing, cooking and gardening and pay only a nominal registration fee.

The facility itself is beautiful and well-run, and all the students are excited to take their learnings and turn them into a business. The average income post-training is close to 15,000 ariary (~$4.40) a day, more than double the national average. It’s hard to call this center anything less than life-changing.

There’s also a listening center on site, where women and men can come to speak to counselors and gain advice on family- and gender-based issues. One of my favorite things there were these postcards depicting different situations a woman may encounter (e.g., physical abuse, economic abuse); on the backside of the postcards there is information about the rights a woman has in the situation, recommended steps to take and support resources to reach out to. What a good, simple, useful tool for people in difficult situations.

As you can imagine, this center has needs that are unfulfilled and we spent a bunch of time with the director better understanding what the most pressing ones are – which ones could best help them expand the center’s impact. I’m going to write up all the needs for the places we visited in a separate post, and would love your support in helping to fill some of them. More to come, but just noodle on it for now, please 😉

Stop 2: University Hospital of Befelatanana

Our second stop of the day was the biggest maternity hospital in Antananarivo. It is a public hospital, with 85% of the patients at the poverty level; on top of that the hospital is a referral hospital, so it receives the most complicated cases from surrounding areas. The throughput of this hospital is amazing – it sees ~11,500 consultations and ~7,000 deliveries a year (of which ~42% are c-sections). 600 MD candidates and 2,000 paramedics train there each year.

To say the conditions in the hospital are lacking is an understatement. The maternal beds have been soiled twice-through (both the mattress and the mattress cover) and at times they have to put two or even three preemie babies in the same neonatal incubator because they don’t have enough.

The UNFPA funded the below birthing unit, which has 11 partitioned areas for women to give birth. We met one woman who had just given birth an hour before (naturally) and she was smiling and chatty. I was so impressed – if that was me, I would be all “GET AWAY NOW!”

UNFPA funding is critical to this hospital, who, in addition to the above, refurbished the surgery block, donated significant equipment, provides over 1,000 c-section kits a year and also funds the pre-natal and family planning services (see why I love the UNFPA so much?). It’s difficult to think about what the experiences of these patients would be like without the support of the UNFPA and other funding partners.

Stop 3: Main Public Hospital (CHUJRA)

Our last stop of the day was the main public hospital in Antananarivo, which is also where the majority of fistula repairs are done in the city (if you do not know what a fistula repair is, click here to learn more about it). This hospital holds fistula repair “camps” each year, where women are brought in from rural areas to have their fistulas repaired. The whole process of pre-op, surgery and recovery takes about three weeks, and the women are also provided housing for this time.

The UNFPA fully funds the fistula repairs and has also contributed to refurbishing the Gynecological Center wing and the model Family Planning center for the Antananarivo area. The Family Planning center sees 1,600 people a year and offers free non-surgical contraceptives on location. Talk about being a real service to the community!

Some of the most impressionable pictures of the day

We learned so much and were so impacted by our time with the UNFPA and its partners in Antananarivo. I am working on how to best present the needs we’d like to fundraise for (a bed pan is only $2!) and will definitely come back to you all with some options, should you like to help (and I hope you do!).

One of the other things that I really appreciated from our time with UNFPA Madagascar was that we got to see a side of “real life” in Tana – a side we wouldn’t have seen just walking around the tourist-y areas. I feel so fortunate to have seen the real lives of real people in Madagascar’s capital city.

That being said, another one of my favorite parts of the day was just driving around the city and looking out the window, watching people in their day-to-day. Here are some of my favorite pictures from that time.

To start with, the outskirts of Antananarivo are full of rice fields. Rice is a main crop for the Malagasy people, and it is the main staple of the Malagasy diet. While most tourists eat a lot of meat when they visit the country, most locals can’t afford to eat meat at every meal, and instead have a rice- and cassava-based diet (especially in the countryside).

The first picture below is a fun one. Each day this vendor (and other vendors) hang up the newspaper page by page, and people who are walking by stop and read the happenings. It was really neat to see.

The first picture below is a big lake that is in the middle of the city. It is a man-made lake (by the former colonizers) and the former palace is behind it. Now there is a beautiful park around it and the locals enjoy the area, which was nice to see. In the second picture below you can see the boy on the oxen cart through the window. While it’s not the fastest form of transport we learned that it is the most effective, as the ox can go on land, through rivers, in any weather, in any incline or decline, and all while carrying huge loads on their backs!

In the first picture below this you can see the buses of Antananarivo. They are big vans that drive through the city and people just hop on and off as the van is moving, mostly through the open back door. Seems efficient to me!

Up next – on to Tulear (aka Toliara)!

After our long and rewarding day it was time to head to Tulear (aka Toliara), on Madagascar’s southwest coast, to see more of the UNFPA’s work there. Excited to share that with you as well! (And dang, look how beautiful the view is over Antananarivo on the way out)