Announcement Archive

International Medical Cooperation in Madagascar

Thursday, July 15th, 2010

story from Tokyo Development Learning Center

Sister Makino and patient with her newborn baby at the Ave Maria Maternity Hospital. Antsirabe, Madagascar. Photo by Y. Fukunaga

105 participants crowded in to the video conference studio at the World Bank Tokyo Development Learning Center (TDLC), on May 12, 2010 to listen to two Franciscan Sisters, Yukie Makino and Michiko Hirama talk about their experiences of working as medical staff in Madagascar.

The event was hosted by TDLC in partnership with a group of volunteers who support Sister Makino (“Sister Makino Wo Shiensuru Kai”), Japanese Medical Support Network (JAMSNET Tokyo), and the Embassy of the Republic of Madagascar in Tokyo in commemoration of the International Midwives’ Day (May 5th ) and International Nurses’ Day (May 12th ). It was planned in hopes of showcasing contributions made by the Japanese in the field of international medical cooperation and providing an opportunity for interested persons to learn more about Madagascar and international medical cooperation: how one can become involved and what to expect in the field.

Sister Makino, 77, midwife at the Ave Maria Maternity Hospital in Antsirabe, Madagascar has been in the country for over 17 years. Sister Hirama, 70, based in the country’s capital, Antananarivo, has been working as a nurse in Madagascar since 1992. The two gathered at the Madagascar Distance Learning Center in Antananarivo to speak to in front of an eager audience in Tokyo through a video conference (VC) connection.

Also present at the Tokyo venue was Mr. Jeannot Feno, Minister-Counsellor of the Embassy of the Republic of Madagascar in Japan.  He opened up the floor with an introduction of the country, an island of an area of approximately 1.6 times that of Japan off the Southeastern coast of Africa, explaining that despite the land being rich in biodiversity and agriculture, Madagascar still remains classified as one of the poorest countries in the world.

According to the most recent figures available in the World Bank’s database, life expectancy at birth in Madagascar is 60 years old, compared to a world average of 69 years and 82.5 years in Japan.  106 children in every 1,000 newborns are likely to die before reaching 5 years of age in Madagascar while the average under-5 mortality rate for the world is 67 per 1,000 and 3.5 per 1,000 in Japan. The maternal mortality rate (number of women who die during pregnancy and birth per 100,000 live births) in Madagascar is 510/100,000, compared to a world average of 400/100,000, and 6/100,000 in Japan. Women in Madagascar have an average of 4.72 children (fertility rate).  From figures in 2005, 68.7% of the population in Madagascar lives on less than $1.25 a day.

Although Sister Makino encourages pregnant women to come in for check-ups which are free for the first 3 times of a pregnancy at her Maternity Hospital, she explained to the audience that prenatal care is still difficult to afford for many woman.
“Some women visit monthly, or only sometimes, and others come right after realizing that they are pregnant only to come back again when they are approaching their due date. Still another group of women only come to give birth.” Sister Makino explained that from time to time, she accepts payments made in installments or payments made in apples or carrots from patients who cannot pay in cash. She said that the hospital is constantly in the red.

The hospital where Sister Makino works receives about 250 to 350 patients every month. Although there are other hospitals nearby, many patients prefer to come to Ave Maria Maternity Hospital for financial reasons.

After a 3 year quest, a surgery facility was added on to the Ave Maria Maternity Hospital in 2008, from funds put together by Japanese donors. Before this, the Hospital was forced to send some of its patients with complicated deliveries to nearby hospitals. Once, a woman going through an obstructed labor and in need of a caesarian refused to be transferred to a different hospital and begged Sister Makino to take out her baby, even if it she had to die, said Sister Makino.

Since 2009, due to the sheer demand by so many patients like the woman described by Sister Makino, the Hospital started to provide C-section operations at the new surgery room for patients with complicated deliveries.

The Hospital has 3 doctors in areas of internal medicine, OB/Gyn, and pediatrics, 2 nurses, 8 midwives, and about 10 assistants and trainees. A younger generation of midwives and nurses has become trained at the Maternity Hospital, so Sister has passed them on the role of attending normal deliveries. Nowadays, Sister mainly looks after premature newborns and low birth weight babies and attends difficult deliveries.

Due to the high number of patients, the two infant incubators at the Hospital are almost always occupied with 3 babies in one machine, allowing up to 6 prematurely born babies access to oxygen.

Babies who are born weighing less than 1000 grams have very little chance of survival, Sister sadly explained.  She cares for the babies night and day, and when a baby’s weight reaches 1400 grams, the baby is taken out of the incubator to make room for others. Sister encourages breastfeeding, but because the mothers themselves are often times malnourished, she relies on powdered milk sent by Japanese donors.

“The babies gain weight beautifully with the powdered milk sent from Japan!” marveled Sister Makino. “When the baby weighs 1600 grams, the baby is discharged from the hospital”, she explained.

A “normal” birth weight for babies is considered to be around 2800g to 4000g, and any infant weighing under that would most likely remain in an incubator in Japan…

Sister Hirama, complemented Sister’s Makino’s presentation and briefed the audience about the political background of the country. She said, “I never cared much about politics when she was living in Japan, but living in Madagascar has made me realize how politics can really affect the daily lives of the people.” 

When Sister Hirama first arrived to the country, there were piles of trash everywhere. The country was crippled by an all out strike and some communication channels were shut down to control political dissent. The country was in middle of a complete turmoil: the trash hadn’t been collected because most state functions had come to a halt. A coup d’etat in March of 2009 resulted in foreign countries cutting off aid to Madagascar and many foreign invested factories and businesses pulled out from the country.  Unemployment and homelessness became pervasive, said Sister Hirama.

In 1991, all state nursing schools were shut down because the state could no longer finance them. In 1993, the St. Francis Hospital, where Sister Hirama works, was assigned by the state as a nursing school, and in 1996, it became the first private institution that could issue nursing licenses to its students. Since then, Sister Hirama has been training nurses, but the main responsibility she has at the hospital is in maintenance and management of medical equipments.

When Sister Hirama first arrived to the hospital, she was shocked to find trash and medical equipments bunched in to the cabinet, making it impossible for her to figure out which tools were clean and which tools were used. Everything was jammed in to a cabinet and locked up with a key. When she asked the hospital staff,  “who is in charge of maintaining the equipment?” the reply she got was:  “Everybody with a nursing license.” She soon learned that everything needs to be locked up and counted periodically because things, medical equipment, even cutlery and linen tend to disappear.

In all of Madagascar, there are only two CT scan machines, and when one of them breaks, it usually takes about 2 to 3 months for repair. Equipments that people in developed parts of the world find basic such as ultrasound and x-rays, are not available in some hospitals in Madagascar. At a state hospital, when one needs a surgery, the individual is responsible for buying the alcohol, syringe, bandages, etc.  Ambulance services are charged, and medicines are expensive. Sister Hirama says, children under the age of five who die in Madagascar die from simple causes such as diarrhea, which are preventable with better sanitation. Money determines life and death for many in Madagascar.

Sister Hirama, despite the lack of resources and economic hardship that the people face in Madagascar, she says she is heartened by the shiny bright eyes of the children of Madagascar. Sister Makino also added that Madagascar is a “captivating country where everybody is warm.”

Sister Makino gave advice to those seeking to go work in developing countries that besides being healthy, it’s important that they make an effort to like the people and the land. She said, one must also be very patient and persevere to build a good relationship. Communication is not about learning the language. “It’s the heart that’s important” said, Sister Makino.

The reception at the end of the session provided a networking opportunity for participants to meet other like-minded individuals and a VC connection booth was set up to allow individuals to speak to the Sisters.