Via today's Globe and Mail, an excellent long article by columnist Tabatha Southey: Forgotten stories from the forgotten land of Madagascar. Excerpt:
Rural poverty can be dangerously easier to digest than its urban counterpart. A child with no shoes on a city street, and I saw many in the capital, Antananarivo (known locally as Tana), is poor – we feel it. But a child with no shoes in the country is often, somewhere in our minds, on holiday. That 12-year-old boy you see ambling down a dirt road in a small town in Madagascar isn’t Tom Sawyer.
First of all, in all likelihood, he’s 17, not 12. Almost half of the country’s children are stunted, Likely nothing in that boy’s appearance will inspire a Christmas fundraising song. He may not have the telethonic severe acute malnutrition, although 15 per cent of children in Madagascar do, according to UNICEF, but odds are 1-in-2 50.1 per cent (UNICEF again) that this boy has suffered the less newsworthy chronic malnutrition, hence the stunting.
Asked if she has encountered MDRTB (her training is as a doctor’s assistant) Sister Immaculata, originally from Spain, seems not to grasp what that is. She wasn’t the only person in the TB trade who appeared to have a knowledge gap in this area – and a diagnostic facility chasm.
The UN World Health Organization estimates that 0.49 per cent of all TB cases in Madagascar are MDRTB but for the most part no one I encountered seemed fussed about any of this.
Many patients sit on the porches of the TB wing, three parking spaces or so from the area for non-TB patients. A bright Candyland-like trail of empty pill packets, treatment for TB, runs along the path between the two.
We are social animals.
Here, as in other TB treatment facilities I visited, the attitude toward transmission seemed casual. I felt goofy wearing a surgical mask, which I studiously did on these visits. The looks I was being given reminded me of the looks we in Canada give Americans when they turn up in October wearing parkas.
Maybe in Madagascar, a country that had 15 cases of polio in 2015 add: (Canada hasn’t had one since 1977) and where malaria, the country’s biggest killer, accounted for 551 reported deaths last year, although some estimates say as many as 7,400 have died since 2013, that’s what TB currently is. It’s a mere medical October and no one wants to be reminded of the winter coming.
Madagascar has, after all, been incubating the perfect conditions for TB transmission for some time. It spreads quickly among those weakened by other illnesses, those living in close quarters and the undernourished.