A Medical Elective in Andavadoaka

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Liz and I arrived at Coco Beach at the beginning of September, ready to undertake our medical elective (a six week placement in a “healthcare setting that differs from the NHS”- cue a mass exodus of fourth year med students to the 4 corners of the globe…). The plan was to join up with the FISA (family planning) project set up by BV in 2007 and conduct our own research project focusing on the clinic’s interaction with young people in the local area. Our first 3 days fortuitously overlapped with the end of Medical Director and family planning project founder Vik’s latest stay, so we were rapidly immersed in a crash course in family planning, dive and expedition medicine and the importance of making the most of our idyllic setting and local rum! His enthusiasm was contagious and we were soon planning our own project. However we were both surprised and a little daunted to learn that the educational intervention to be developed as a consequence of our research would be a play; written, produced and directed by us! Drama not being a core module in our particular medical course, we were initially politely positive about the idea but Vik’s unfailing enthusiasm and the sincerity and concern with which he spoke about the issues facing the young people of the region won us over.

We have attended family planning clinics here in Andava as well as the satellite clinics in Belovenoke in the north and Tampilove in the South, collecting the demographic info from patient records and hearing the stories of the women who come to access contraception and counselling from Fanja (the Malagasy lady who runs the clinics). I am continually shocked by the number of children many of these women have had and by how young an age- I’m beginning to feel that I have some catching up to do! The journeys to the clinics make the ease of my daily trip to the hospital in Brighton almost laughable. Normally reached by motorized pirogue (the local fishing boats), Belovanoke is, it transpired one morning when the expected boat captain failed to arrive, a 6-hour round-trip by sereti cart (i.e. a high wooden cart on dodgy looking wheels and no suspension pulled by 2 zebu in dire need of Imodium). The mattress we were cunningly advised to put on the floor softened the ride a little but nothing can prepare you for the flying zebu poo and the inadvertent head-bashing when you are thrown on to your fellow passengers. We finally arrived home battered, bruised, sunburnt and more than a little delirious.

On another memorable occasion the usually wet and choppy pirogue trip to Tampilove was stopped in its tracks by the unforeseen low tide. We spent the following hours trekking through the mangroves, sitting and waiting for the channel to fill and finally pushing the boat whilst dodging evil-looking sea urchins and slimy algae patches. On the upside, it seems pirogue-pushing is an excellent workout for the thighs…

We have now run 2 focus groups with the young people of the village and, having asked them about their use of family planning and the dynamics of their relationships, we have constructed the basis of our play. It has been designed to let teenagers know that the clinic service is available to them and that if they complete their education and have children later on, they have that choice. It is to be performed by ‘vazaha’ (us!) in order to create a bit of a spectacle and attract as much attention as possible. The latest batch of vols have proved suitably enthusiastic and, all going well, our directorial debut should go ahead on Saturday 10th October.