Field Note June 17, 2014

PIVOT’s first steps

REFLECTIONS FROM

I came to Ranomafana after having worked in the south of Madagascar with Médecins Sans Frontières. Ranomafana is like paradise to the eyes after the dry south, hills of green and constant rain much of the year, living in the clouds almost. While being a haven for nature, part of which is protected by the oldest national park set up by Pat Wright, the district, a 10 hour drive from the capital, Tana, presents its own challenges: our first trip out to try to visit health centres was cut short, 10km from our destination. 10km but maybe a 1 to 2 hour drive! We turned back when the car looked like it was about to turn over!

The drivers are more courageous than us!  Some of the health centres are a 3 day walk, and that’s after a motor bike ride as far as the road allows to points more distant than where we turned back from. The health centre we were planning to visit has just one nurse who works alone. As part of their monthly minimum package of activities, she walks a full day to reach some of the more distant sites which are attached to her health centre. Many people understandably prefer to go to the traditional healers or “midwives” and the health centre is the last recourse, often too late. Part of our work is going to be about attracting people into the health centres: good care, free care for those who can’t pay, happy health workers who feel valued and supported and are happy and able to respond; the other part will be about going out to them: walking a few days with the community health workers to reach the furthest villages and support the communities.

That’s what PIVOT is about for me: being side by side with those who need care, side by side with those who face the challenge of providing that care with very little support, being side by side with those who are attempting to facilitate the work from district level and ensuring at each level quality care is available.

We’re starting with 4 health centres to make sure our accompaniment reaches the level of quality care we intend to spread throughout the district, by the end of 2 years we hope to have reached the whole of the district, and we know that will mean being very inventive: setting up ambulance relay points for emergencies from health centres where there is no means of communication, working with communities and traditional healers and leaders in villages which can only be reached by crossing raging rivers, walking through forests where there’s illicit gold mining. Even with all these challenges, we are already getting more and more referrals each week and some from remote health centres, and patients are reaching the hospital or even referred to the regional hospital and kids are starting to shout “Pivot” when the cars go by. We’re the only healthcare NGO based in the district and people are starting the reach out to us as we make services accessible to those in need. And that’s exciting! And we hope PIVOT-al!!!