{"id":7345,"date":"2015-07-30T16:45:29","date_gmt":"2015-07-30T15:45:29","guid":{"rendered":"http:\/\/bvblog.wpengine.com\/?p=7345"},"modified":"2016-12-12T09:05:18","modified_gmt":"2016-12-12T09:05:18","slug":"new-partnership-vital-health-services-isolated-fishing-settlements-barren-isles","status":"publish","type":"post","link":"https:\/\/blog.blueventures.org\/en\/new-partnership-vital-health-services-isolated-fishing-settlements-barren-isles\/","title":{"rendered":"New partnership brings vital health services to isolated fishing settlements in the Barren Isles archipelago"},"content":{"rendered":"

By Caroline Savitzky, Madagascar PHE\u00a0Coordinator, Blue Ventures<\/em><\/p>\n

I\u2019m standing in the middle of Nosy Lava, the southernmost outpost of a constellation of tiny islands off Madagascar\u2019s west coast. Despite their desolate-sounding name, the Barren Isles sit among one of the few remaining strongholds of thriving marine biodiversity in the western Indian Ocean. To my left, there\u2019s a camp of \u201cVezo Vahiny<\/em>\u201d migrants who have travelled here from as far away as Velondriake in the south and Ambanja in the north. To my right, there\u2019s a camp of \u201cZanan\u2019tany<\/em>\u201d visitors from the nearest large town of Maintirano. Both of these groups are here in pursuit of better fishing grounds, and both struggle with the enormous health challenges present in such extreme conditions.<\/p>\n

\"Vezo

Men migrate seasonally, sometimes with their partners and children, up to 1,000 kilometres in outrigger pirogues in order to reach better fishing grounds in the Barren Isles. Photo \u00a9 Garth Cripps.<\/p><\/div>\n

I\u2019m here to find out more about the various health issues that they face, what access to health information and services they already have, and what their priority unmet health needs are, in the hope that Blue Ventures might be able to address these with our health partners. We\u2019ve done this effectively in our first two conservation sites in Madagascar (Velondriake and Belo sur Mer) and, having witnessed the benefits of integrating community health promotion with marine management and coastal livelihood initiatives<\/a>, we\u2019re keen to explore the potential for replicating this holistic approach in the Barren Isles. There\u2019s strong community interest and motivation here, with great\u00a0thirst for\u00a0improved access to information and services, as demonstrated by many people staying on after\u00a0the meetings I convene in order to ask reproductive\u00a0health questions.<\/p>\n

\"Aerial

Aerial view of Nosy Manandra; a slender sand bar island in the Barren Isles archipelago that gets submerged during spring tides or ferocious rainy season storms. It\u2019s home to a camp of migrant fishers; surely among the most under-served populations in the whole of Madagascar. Photo \u00a9 Garth Cripps.<\/p><\/div>\n

Over the course of my time on Nosy Lava, I hold focus groups with different community members; \u201cVezo Vahiny<\/em>\u201d women, \u201cVezo Vahiny<\/em>\u201d men, \u201cZanan\u2019tany<\/em>\u201d women, \u201cZanan\u2019tany<\/em>\u201d men. All face similar health problems; headaches, fevers, feeling dizzy and faint, rashes and open sores (I only see a few children on the island who don\u2019t have fairly large open sores), stomach aches and diahorrea, coughs and respiratory illnesses, mouth ulcers, back pain (especially after strenuous work at sea), frequent likely STI symptoms and unmet family planning needs. There\u2019s a complete lack of access to healthcare on the island.<\/p>\n

\"A

A migrant Vezo family uses their sail and oars to make a tent. Vezo means \u201cpeople of the sea\u201d in Malagasy; so-called because their cultural identity and way of life are intimately tied to the ocean. Photo \u00a9 Garth Cripps.<\/p><\/div>\n

The situation isn\u2019t any better at Beloba, a remote fishing settlement on the adjacent mainland that I also visit. They\u2019re very far away from public health centres, and community health agents can\u2019t reach their village. Their health problems are broadly the same as the island migrants, and they identify family planning as a major unmet need as well. Most of the elderly women here report having at least 8 children, and are very interested in family planning as it\u2019s difficult to support so many children.<\/p>\n

One young woman, aged 17 years with two children, says it\u2019s very hard for her to care for them as a single mother so she\u2019d like to use family planning. Another woman with a 7-month old baby and already pregnant again says she really wants to be able to space her births, while the 20-year old woman with three children sitting next to her agrees immediately. In my focus group with young men in Beloba, several speak up about wanting to use family planning to make sure that they can support the children they have; these concerns also come up very frequently with the men who I speak to on Nosy Lava.<\/p>\n

\"Vezo

Vezo families en route to the Barren Isles. Photo \u00a9 Garth Cripps.<\/p><\/div>\n

Back on Nosy Lava, I note some subtle differences in access to health information and services reported by the two groups of migrants; the \u201cVezo Vahiny<\/em>\u201d only tend to go to Maintirano for medical attention in emergency situations, while the \u201cZanan\u2019tany<\/em>\u201d are strikingly more informed about health issues in general and don\u2019t hesitate to go to Maintirano (where they\u2019re originally from) for routine as well as emergency healthcare, although it\u2019s far away and the feasibility of the journey depends on sea conditions (if it\u2019s rough they just can\u2019t go).<\/p>\n

Many of the \u201cVezo Vahiny<\/em>\u201d women are able to use family planning by stocking up on contraceptive pills from community-based distributors (CBDs) in Velondriake<\/a> before they migrate for the season, or choosing a long-acting method with Marie Stopes Madagascar before making the journey, although their options are generally quite limited. For example, it\u2019s much harder if they prefer to use depo-provera injections because these have to be administered every three months by CBDs, while the women normally go away to the Barren Isles for 9 months each year. Most of the \u201cZanan\u2019tany<\/em>\u201d women are able to access family planning in Maintirano, but say that it would be better if a community health agent could reach them directly on the island, particularly for follow-ups and addressing other priority health needs.<\/p>\n

\"Fishing

Fishing in crystal clear waters in the Barren Isles archipelago; this is the largest locally managed marine area in the Indian Ocean, whose legal status gives traditional resource users the formal rights to manage the fisheries upon which their livelihoods depend. Photo \u00a9 Garth Cripps.<\/p><\/div>\n

Across the spectrum from the fishers in isolated mainland settlements to the \u201cVezo Vahiny<\/em>\u201d and \u201cZanan\u2019tany<\/em>\u201d migrants on remote islands, it quickly becomes very clear that there are an array of basic unmet health needs that we could usefully address in the Barren Isles, with various nuances according to population group and location. This is confirmed during my time in Maintirano town, where I meet with Ministry of\u00a0Health\u00a0officials, partner\u00a0health\u00a0NGOs, public health centre staff and\u00a0community\u00a0health\u00a0agents to get their views.<\/p>\n

Collaboration between\u00a0these health\u00a0service providers seems common already, and there is great openness to\u00a0working together and being flexible in approaches in order to reach different isolated areas. Building on Blue Ventures\u2019 strong existing partnership with JSI\/MAHEFA* in Belo sur Mer (where they\u2019ve trained local women as community health agents<\/a> to provide health education and offer contraceptives in the villages where we support local marine conservation efforts), we discuss the possibility of working together in the area to train a few new community health agents in some remote mainland settlements like Beloba, and to have community health agents join Blue Ventures visiting the islands\u00a0like Nosy Lava whenever we go there to facilitate marine management meetings.<\/p>\n

\"Women

Women and children at the migrant fishing camp on Nosy Manandra; until now, there\u2019s been a complete lack of access to healthcare on all of these islands in the Barren Isles archipelago. Photo \u00a9 Garth Cripps.<\/p><\/div>\n

Fast-forward three months and I\u2019m back in Maintirano, having signed an exciting new partnership agreement with JSI\/MAHEFA, in order to assist with the training of three new community health agents in a full package of basic healthcare provision!<\/p>\n

From short-term contraceptive options to the management of common childhood illnesses like diarrhoea and respiratory infections, JSI\/MAHEFA\u2019s fantastic team take the new community health agents through a comprehensive curriculum of training and role-plays. On the third and fourth days, I have a few slots to facilitate special sessions about Blue Ventures\u2019 holistic approach to integrating health promotion with natural resource management and alternative livelihoods, so that they can sensitise their communities about the links between these different initiatives. We approach these sessions with the use of games and active learning, as the connections between human and ecosystem health are easily identified and understood in a place where life is deeply connected to the natural environment.<\/p>\n

\"JSI\/MAHEFA

JSI\/MAHEFA provides training in the management of common childhood illnesses; the new community health agent\u2019s baby gets involved in a role-play! Photo \u00a9 Caroline Savitzky.<\/p><\/div>\n

Together with the Ministry of Health, JSI\/MAHEFA and other health partners in the region, we\u2019re hereby developing an effective and flexible model for bringing vital health services to isolated fishing settlements in the Barren Isles archipelago; a very different and arguably more challenging context than our first two conservation sites. We look forward to building on this promising start over the coming months, including exploring the possibility of doing some more focused environmental education training for\u00a0 community\u00a0health\u00a0agents\u00a0with our conservation partner WWF (whose team kindly transported me from Morondava up to Maintirano with them last weekend, passing through Belo sur Tsiribihina where they\u2019re also working with JSI\/MAHEFA to coordinate activities).<\/p>\n

It\u2019s clear to me that this a time of great motivation and potential in the Barren Isles area. A management committee for the locally managed marine area<\/a> has just been formalised, partnerships between health and conservation organisations are being enacted, and communities are both seeking and addressing their rights to access family planning and marine resources!<\/p>\n

\n

*With thanks to our partner JSI\/MAHEFA for their valuable\u00a0collaboration:\u00a0<\/em>The USAID-funded Madagascar Community-Based Integrated Health Project (CBIHP), known locally as MAHEFA, is a five-year program (2011-2016) implemented by JSI Research & Training Institute, Inc.<\/a> that provides basic, quality health care to isolated populations in six of Madagascar\u2019s most remote regions.<\/p>\n","protected":false},"excerpt":{"rendered":"

Blue Ventures links up with JSI\/MAHEFA to provide family planning options and basic healthcare to remote communities in the Indian Ocean\u2019s largest locally managed marine area.<\/p>\n","protected":false},"author":103,"featured_media":7359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[206,345,463,338,468],"tags":[499,505,485,486,484,506,487,488,492],"class_list":["post-7345","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-barren-isles-madagascar","category-community-health","category-featured","category-lmma","category-fisheries","tag-coral-reef","tag-family-planning","tag-marine-conservation","tag-population-health-environment","tag-rebuilding-fisheries","tag-reproductive-health","tag-rights-based-management","tag-training","tag-womens-empowerment"],"yoast_head":"\nNew partnership brings vital health services to isolated fishing settlements in the Barren Isles archipelago - 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