In February, Cyclone Batsirai and Cyclone Emnati hit the east coast of Madagascar just weeks apart, destroying numerous health care centers and impacting more than 150,000 people. In response, emergency teams from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières’ (MSF) are providing care to people in isolated rural areas most affected by the damage.
Providing services in places with limited access to health care and other essential services is critical but difficult work. It takes almost two hours for the MSF emergency team to cover the 12 miles [20 kilometers] that separate the city of Mananjary—where MSF is based since Cyclone Batsirai hit—from the village of Mahatsara Lefaka. There, the roof of the health care center has been ripped off along with 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 been working at the health care center in Mahatsara Lefaka for 18 months. “Today is the first time that I have come back in three weeks.”
On this day, she is accompanying the MSF team as they provide consultations to the many residents who have come to the village school, where they run a mobile clinic. For nearly a month, most people here have not had any access to health care.
Among the 37 people seen that day was a child of nine months who had an infected abscess. His leg was wounded in two places and, without antibiotics, he risked going into 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 has deteriorated because he has not been able to get any care. 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 their priority was to rebuild the roof of their house and to find water and food. They don’t have the means to pay for any new medical treatment.”
Lack of shelter exacerbates illness
Most people affected by this most recent cyclone had managed to repair their houses after Cyclone Batsirai, but construction materials are in short supply and expensive, making it prohibitive to rebuild houses for a second time.
“Many people were injured during the first cyclone by the wood and the sheet metal that was ripped off by the wind,” continued Vololoniaina. “People who didn’t have any shelter fell ill, they coughed, and we saw that people also had diarrhea because they were drinking polluted water from the river.”
The team also treated people with respiratory infections, malaria, and chronic diseases. “Of 19 people tested, 11 were positive for malaria—and that’s only the people that were presenting symptoms,” explained Dr. Johnson Heritiana. “It’s the season where normally we see a peak in malaria, but the pools of stagnant water that have collected after the cyclones have aggravated the situation.”
Treating patients in a precarious situation
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 treatment isn’t available in our health center, we have to refer them to Mananjary. It takes more than three hours to walk to the city, and many people don’t go because they think that they will have to pay for care.”
The limited access to care has always been an issue in the region, but the destruction of the health center and damage to the main road are isolating people in Mahatsara Lefaka even more. Many non-governmental organizations are struggling to travel there and must use all methods of transport available—from walking to canoes—to get there and evaluate people’s needs.
Other even more remote areas are more deprived of humanitarian assistance, and telecommunications are still not available in numerous places. MSF teams have carried out more than 250 consultations in rural areas of the district of Mananjary since the beginning of our intervention. This is in addition to more than 100 consultations per day in tents set up by MSF at the public hospital of Mananjary, which was destroyed by Cyclone Batsirai.
