Poison

        In Madagascar, if ever you want everyone in your village to know something, inform the ladies that own and operate that little stores. These stores are the center of all gossip and news about the village and national events. For example, I went to Mme Marguerite's store in my village the other day to have a cup of coffee. While sipping the way-too-hot cup of way-too-sweet blackness, she whispered to me about a scandalous event that had taken place in the town just the previous afternoon (I had missed the evening edition the day before, obviously). A boy in my town of about 14 years old was left in charge of preparing lunch while his stepdad went out to work the fields, getting ready for rice planting. The boys mom was out of town in Tamatave, the coast city, for work. Upon arriving back home from the fields, the boys stepfather serves himself some rice from the pot. Upon smelling the rice that she had just placed on his plate and was about to consume, he noticed a strange smell coming from the rice: rat poison. Apparently, the boy had tried to kill his stepfather. The story goes: while the man was out in the fields working, the boy discovered a note addressed to his stepfather, a note from another woman who was not his mother, possibly a love note. Angered, the boy purchased rat poison, added it to his stepfather's rice in an attempt to kill him for his cheating ways. The boy got caught, the gendarme were called, the boys mother was called, and that's all I know cause I stay out of the village drama. And again, this is just what the store owner told me, so take it with a grain of sea salt. Lesson 1: If you're gonna cheat, smell your rice. Lesson 2: Don't try to poison a food that should have no smell with an odorous poison.

Where does it not itch?

         For about a week, I was lucky enough to work as an interpreter for a medical mission in the Tamatave region of Madagascar. Tamatave, aka Toamasina, is home to the biggest port on the island and is the doorway of most all economic activity here. The medical team was made up of 8 Americans who form the Caring Response Madagascar Foundation (CRMF). For about 10 years, they have been coming to Madagascar and giving clinics and providing medicines to Malagasy who otherwise could not afford care. Five other PCVs worked with the team to interpret for the doctors and the ailing patients we saw. My first day on the job, we went to the prison in Tamatave to give a clinic there. Criminals be warned: a prison anywhere is no place you ever want to be but a prison in Madagascar and the conditions therein should serve as a strong deterrent for even the most petty criminal. As fellow PCV Sam Williford put it, It looks like the scenes from the future in "The Terminator" just without the skulls. I was teamed up with a doctor named David, a pulmonary specialist. This was his first time practicing third world medicine (it was mine too). Most of our patients that day complained of chronic stomach aches, worms, and weight loss, all likely effects of poor living conditions within the prison. However, the most memorable case was the poor fellow with a full body rash. David called over our fellow physician, Jack, who has been practicing developing country medicine for 10 years, to observe the case. Jack took a quick a look and gave a quick diagnosis: it was the worst case of scabies he had ever seen. The guy was covered from neck to foot in the affliction. David prescribed him several topical and oral medications and recommended that he be separated from the other prisoners for about a month due to the contagiousness of his condition. I called over the prison nurse and informed him of the need to isolate this particular case before other prisoners became afflicted. He informed that it was indeed possible to put the prisoner in a place where he wouldn't spread the scabies to others. After thinking about this for a minute, I realized that, in other words, I had just told the prison to put this poor SOB into solitary confinement for 30 days. Never before, nor never will I again, sentence a man to 30 days in the hole.

     Following the day at the prison, we went out into deepish countryside to a place where a few sisters, with the help of several NGOs, had set up a fairly functional medical clinic. We spent two days at this location seeing patients. One of the biggest ailments that the sisters diagnose and treat in their area is tuberculosis, a disease that has pretty well been eliminated from the American household conversation. My physician partner, David, being a pulmonary specialist, and I received most of these TB cases. Most folks who came in to us complaining of chest pains, coughs, and fevers mostly had already been diagnosed and given treatment by the sisters, a service that the sisters provide completely for free, thanks to international donor support. Most folks that we saw simply hadn't given the treatment long enough to take effect; someone afflicted with TB must undergo 6-8 months treatment before they are cured of the infection. One lady that we saw came into us complaining of TB like symptoms. I asked her if she had done a TB analysis at the clinic and she said yes. I then asked her if she had begun taking the treatment once she had been diagnosed with TB and she told me no. When I asked her why she had not received the treatment, she simply replied that she didn't know and danced around the topic. I went to one of the sisters and asked about this ladies case and why she had not received TB treatment. Sister Christine then told me that this one particular lady was "crazy" and has refused treatment because she was afraid of taking medication. As I'm sure this lady had been told before, I had to inform her that if she did not take the treatment she would likely die a very slow and painful death over the next 2 years, and also be a risk to those living within her community. When asked, she informed us that others in her household were also infected with TB and were also not receiving treatment. We told her that they also would likely be dead in the next 2 years. David informed me that in America, if one were infected with TB and refused to take treatment, you would likely be put on house arrest (or taken to prison) and forced to take the medicine to cure the disease because when it comes to public health, we will tend to sacrifice the rights of the individual over safety of the public. This lady, however, due to her fear of medication, will likely not live to see 2015 and may also infect many others in her community.

      The first patient that David and I saw in the countryside clinic was a 61 year old man who was skeletonized from malnutrition and sick with TB. After checking the patient's vitals and performing an exam, David had me tell the family of this man that he would likely be dead in 2 weeks and that there was nothing that we nor the hospitals could really do for him at this point. Well, who would have thought that this humble, naive PCV would ever have to give that kind of news to someone. The next patient David and I saw was 15 year old boy with jaundiced eyes and a distended belly. This poor kid was afflicted with TB, malaria, typhoid fever, intestinal worms, amoeba dysentery, and malnutrition. We had to inform the parents of this boy that there was nothing within our power that we could do to help him but that they (the doctors) would pay for him to go the hospital in Tamatave. This was his only chance at getting the treatment he needed. I don't know what happened to this kid, but I hope he's getting better. That's one of the problems with these kinds of medical missions where doctors come on these mission trips with their clinical expertise and their free medicines and their money for hospital visits and their very big hearts, but there's never much possibility for follow up.

       We saw many other patients that week, but I'll leave you with just these few examples. On another note, during our work with doctors, we were housed at the ONG St. Gabriel, an organization on the outskirts of Tamatave that is run by Indian immigrants. The folks at St. Gabriel (Sylvester, Edwin, and Selbom) are some of the most welcoming individuals I've ever had the pleasure of knowing. The food there, morning and night, was some of the most delicious I have ever tasted in my life and I will forever remember how content and at home they made us feel at their place. If you've never eaten home-made Indian food, get off your behind and get some. Also, Malagasy people take note, the Indians and Pakistanis are kicking your butt with the whole quality of rice thing. Get on it.

    I miss all you folks back home very dearly. Looks like I've got a ticket to Rome, Italy here in about 2 weeks. Austin and Jill Rios, Jared Grant, this mug's coming and he's hungry. See ya soon.

Take care everyone and stay outta trouble,

James

The Women's Cooperative

       Several months ago, I was approached by a Malagasy man from the capital who was helping a group of women in my village to form a cooperative in which they would produce and sell a medicinal plant that grows in our area of Madagascar. This fellow was apparently the contact point for buyers in Tana. He asked if I could help the women get all of their papers in order to file with the government so that they could become a legal cooperative and sell the raw plant as an association. As a cooperative, the women would have stronger bargaining power for the prices of the plants. This fellow also asked if I could help provide the women with the tools and materials that they would need in order to carry out this project now and for the years ahead. So, thanks to the generosity of so many people, I was able to provide these ladies with everything they needed: shovels, wheelbarrows, scythes, cooking pots for long days in the fields, etc,. The Malagasy name for the plant is "Ampelatsifotra" and it falls under the Desmodium genus. The plant is bought by buyers in Tana, then is sent overseas to be processed into medicines that help to treat such ailments as hepatitis A,B, and C, uteral cancer, and asthma. The cooperative is cultivating the plant in areas surrounding our rain forest that have previously been cut and burned for rice cultivation. The ladies are also starting to grow trees for our reforestation efforts.  Here are a few pictures of the work they are doing:

Thanks are particularly in order for the following individuals and groups!!

Mrs. Betty Shelton
Mrs. Sandy Haddad
Mrs. Helyn Keith
Mrs. Anne Spencer
Mrs. Judy McQueen
Mrs. Suzanne Rhea
Mrs. Roberta Parker
Mr. Willie and Mrs. Lucinda Williams
Mr. Rusty and Mrs. Kris Bliss

The Wesley Room Sunday School Class

The Pairs and Spares Sunday School Class