Why this medical project ? Our Findings....

For many years, we have been traveling in the family in Madagascar and are experiencing growing difficulties that push us to act :

Observations of great difficulties in Madagascar:

 General economic situation of the country:
Madagascar is one of the 10 poorest countries in the world with a GDP of 440 USD / year / inhabitant, i.e. around 450EUR / year / inhabitant and a legal minimum income of 30EUR / month, which is insufficient to cover the family expenses of the month. (GDP = Gross Domestic Product calculates the "wealth" produced per year and per capita, on average, which gives an idea of the average standard of living)
By comparison: In Europe the GDP per capita is 35,000EUR / year / inhabitant and in France 32075EUR / year/Inhab. in 2016.
The country has 23 million inhabitants and is as large as France and Benelux combined.

Map of Madagascar

The density is 40habitants / km 2 (France 121 hab / km2); It is relatively weak. The capital Antananarivo is home to more than one million inhabitants, living in very difficult conditions due to lack of organization, of housing, of road network (3 hours to reach the city center by car) from the suburbs, poverty, rural exodus, etc. It is a dangerous city where brigands rage. By car, it is necessary to roll closed window.
A view of Tananarive from the suburbs

The literacy rate is 60% (2010), which means that 40% of Malagasy people cannot read or write and are therefore very vulnerable.
Malagasy political choices from 1975 to 1990 to move towards marxism, to confiscate land, to collectivize it, to abandon French to Malagasy exclusively in education, etc. have had serious consequences on exclusion of « the large island « of the world map of economic and cultural exchanges. The fall of the Berlin Wall in 1989 and the new political orientations did not lead to a recovery of the country.
So, the political crises that have followed one another for many years or strikes have caused a general instability that does not give investors confidence. The potential for development is real but is wasted by anti-economic and anti-social behavior.

The electricity problems of Jirama, which provides only 1 hour of electricity per day in certain areas, such as Fénérive-Est, incessant discharge, illegal connections, fuel theft of thermal power plants, etc.. provoke the defiance of Investors, economic operators, tourists ....
Photo company Jirama (electricity and water supplier) in Nosy Be island

Water, unfit for consumption , makes Malagasy sick but also tourists, despite their precautions.
Photo shop of bread and filtered water in Tananarive

Corruption is implemented at all levels of the civil service and can be seen on the streets very easily by untimely roadblocks of the police, military, gendarmes, ... asking for money without compensation or strong administrative slowdowns as long as the wallet is not taken out, for normal job to be performed. The known corruption index is 25 (on a scale ranging from 0 = systematic corruption to 100 = no corruption). Source NGO Transparency International.
The very poor condition of the roads leads to great difficulty in traveling. They are long and difficult, humanly and also technically, men and vehicles suffer much on the roads widely holed and never or little redone.
Photo: one of hundreds of garbage in Antananarivo, not cleared

 General health situation:
Life expectancy is officially 65 years but many pregnant women die as a result of childbirth, many children do not reach the age of 2 years. Thus, women make an average of 4.5 children (fertility rate), but infant mortality is 43.67 / 1000 children (France 3.28 / 00) and the mortality of children under 5 is 62/1000 children (France 4/00)

The population is young with 85% under the age of 15, which is very pleasant since the streets are filled with dynamic young people. The Malagasy State has a real challenge: to train and educate its young people properly.
Picture : children in Madagascar / Fénérive-Est

But being sick is a big problem. There is little or no social security coverage. Most of the time, patients have to pay for their consultations, operations and medications. For example, for an operation of a benign brain tumor 6000EUR, in a private clinic in Antananarivo. For a fractured leg, you have to pay its radio 14EUR, a large sum for a Malagasy household. The hospitals are very poorly equipped, even in basic equipment.

(See pictures of the big hospital of Fénérive-Est) – Entry and birth /delivery room

Two recently opened hospitals in Antananarivo and Tamatave were plundered of their equipment the day after the opening.
  At the dental level, 80% of children have caries and this rate rises to 98% for adults aged 35 to 44 years with 13 teeth affected on average. 1250 dental surgeon dentists, including 300 civil servants, provide care.

National coverage is not guaranteed: in remote areas, people have little access to care. To face these difficulties, the oral-dental service of the Ministry of Health of Madagascar is seeking to improve the health status of the population through a preventive approach, with the support of AOI International Dental Aid (source AOI - see document attached and ( http://blog.aoi-fr.org/evaluation-des-medecins-generalistes-communautaires-a-madagascar/

Health situation in Fénérive-Est: map Madagascar and zone FE
The Analanjirofo region (clover forests) - in yellow on the map:

The Analanjirofo region is one of the 22 administrative regions of Madagascar. It comprises 6 districts with a total area of ​​22300 km2 (almost like Lorraine), including the district of Fénérive-Est.

At the health level, various small or larger sanitary structures exist, ranging from Basic Level I health centers to the Regional Reference Center of Fénérive-Est.
According to the 2009 CREAM study, the region includes 2 public dental centers, 12 public maternity wards, 5 private maternity clinics including 2 in Fénérive, 5 private dental offices incl. 2 in Fénérive and the above CHRR, and also drug deposits or pharmacies.

In this region, patients walk 1 hour walk to a health center , 46% of them, 27% walk 1 to 3 hours and 6% walk 3 to 6 hours. 86% of women walk to get to the maternity ward. (Source Cream)

 The city :

The town of Fénérive-Est is the capital of region Analanjirofo. It is located on the east coast of Madagascar, by the sea, and comprises about 30,000 inhabitants.
Photo: Cloves of Fénérive-Est, (available at the Boutique)

It is the capital of cloves and spices. It is also a fishing town. The rice crops are on the edge of the city. Its town center with its market are very lively, hundreds of bike-shovels go through the paved main streets, which are in correct condition. Pedestrians must be careful not to be spilled. Car horns manage the movement of pedestrians, bicycles, cars, bush taxis. There is only one pedestrian crossing in front of the Catholic Church.
Fénérive is a very pleasant city with great people, courageous, pleasant despite their various problems. Security is correct thanks to the vigilance of all. Fénérive is a step city before going south to Tamatave or north towards the island of Sainte Marie.
Fénérive-Est maintains privileged relations with the Nord Pas de Calais region within the framework of French decentralization. Various projects have been carried out thanks to this cooperation.

Photos of the animated streets of FE


At the sanitary level:
At the sanitary level, the town of Fénérive-Est includes a CHRR regional reference hospital , 2 private medical offices, 2 private maternity wards, no private clinic, 5 private dental offices and 6 drugs deposits or pharmacies.

However, as in all Madagascar, small or large medical centers, more or less equipped, do not provide perfect hygiene at all levels. Cross contamination of any kind is the rule.
In dental matters, the lack of various means leads to the non-respect of the decontamination and sterilization chain, little hygiene, etc. even if the theory on hygiene protocols is known to all. The General Doctors or the civil service dentists are aware of the risks of health-related infections and know the theoretical modalities to minimize them. But their systematic application in reality remains difficult.
Picture : private dental office in Fénérive-Est

During our stays in Fénérive-Est we visited various private and public dental offices, talked to the surgeons dentists and the doctors of FE-CHRR, to he population.
Our findings of old equipment, lack of basic means, poor means of patients to pay for medical procedures, problems of electricity, lack of follow-up of the projects put in place, etc. leads to the creation of The association LA CASE EN FALAFA.