15 May 2019 Staff Spotlight: Onja Randriamiaranjatovo and Sophie Rasoatsilavina
Prior to uprooting their lives to work for PIVOT in 2015, Onja Randriamiaranjatovo and Sophie Rasoatsilavina had lived, studied, and worked in Madagascar’s bustling capital city of Antananarivo for their whole lives. After some years holding various clinical positions – from volunteering for health organizations to working in private clinics – the couple were ready to relocate to somewhere more remote, where they felt they could use their training to make more of an impact. In 2015, each pursued positions with PIVOT and relocated to rural Ifanadiana District. Onja was hired as a nurse and Sophie as a midwife.
After five months of excelling as a pediatric nurse at a PIVOT-supported health center in Ifanadiana, Onja was assigned to launch the malnutrition program in the even more rural community of Tsaratanana. Getting to Tsaratanana Health Center involves a sharp turn off of the paved national route onto bumpy, muddy terrain – a drive that lasts for about an hour (or more, depending on the vehicle and the season) before your destination emerges in the distance. He was ready for the challenge.
Sophie continued working where she was needed most, as a midwife jointly-supported by PIVOT and the Ministry of Health (MoH) at Ifanadiana Health Center. The pair would spend the next seven months making the trek to see one another when time allowed. Not long after the couple married, an opportunity opened up for Sophie to transfer to Tsaratanana and work as a midwife in the same remote community as Onja – she took it.
Sophie and Onja met while studying to enter their respective clinical fields, and have been together ever since. They shared ambitions of leaving the city to live life at a different pace and, above all, settle down somewhere that their skills and passion for delivering care could make a lasting difference. The contrast between Antananarivo and Tsaratanana cannot be emphasized enough. Onja and Sophie swapped the abundance of products in round-the-clock shops for small, quiet market days where certain products are only available certain days of the week, if ever. They swapped relentless automotive traffic for dirt footpaths and muddy motorcycle routes. And they swapped working in a big city alongside hundreds of other clinicians to instead live in a community where electricity may be scarce, but their voices are heard and taken more seriously among their small team of colleagues.
Since relocating to Tsaratanana in early 2017, they’ve each settled into positions that are well-suited to their professional passions and strengths. Onja leads the program for treatment of malnourished children under the age of five. Sophie, in addition to her role as midwife, has been appointed by the MoH as administrative director of the health center. The couple is unwavering in their commitment to act strictly as colleagues in the workplace (to a point where it took many colleagues months to discover they were married), Onja and Sophie serve as a living example of how PIVOT’s collaborative partnership with the MoH can have a huge impact on population health.
When asked about the aspects of working for PIVOT that make them most proud, their list is long. Sophie says with a laugh that delivering babies is her favorite part of the job (“which is good, because it is my job”), and notes that, beyond that, Tsaratanana Health Center was recognized for having greatest number of safe health center deliveries in the region during her first year. The “incredible drops to maternal mortality” that she’s seen result from PIVOT’s work have inspired her and strengthened her belief in the organization’s mission.
Onja states simply that he’s most proud of the fact that PIVOT focuses on childhood malnutrition, because there are so many children affected by it in Ifanadiana District. He is greatly fulfilled having a role in helping children and their families overcome needless suffering.
Both say that awareness of PIVOT’s presence, purpose, and impact is high among members of the Tsaratanana community. In their years of work there, they’ve seen an increase in understanding and trust in the public health system. They have observed how the removal of fees for patients has been a game-changer when it comes to a person’s likelihood to come to the health center – in a place where patient visits had once been scarce, one of their biggest challenges today is the sheer number of patients who come seeking care each day.
They are pleased to see that people trust the quality of care at the health center enough to come – often walking kilometers at a time to get there – when sick. “And even when we are not equipped to provide care,” Sophie says, “we work with PIVOT’s referral team to transfer patients to higher levels of care where they can get the help that they need.”
Over the past two years, Onja and Sophie have fully embraced the lifestyle changes that came with their move to Tsaratanana, establishing a home where they welcomed their first child. They recognize that their aspirations to live and work in a remote community differ from those of many young Malagasy couples, but they don’t get caught up in comparisons. In the context of both personal and professional endeavors, the couple lives by a Malagasy adage that says, “Do not put yourself in competition with others, but exceed your successes of yesterday.” Their adherence to this philosophy is evident both in their conduct as healthcare providers, and in their commitment to continue serving the community of Tsaratanana. With no plans to relocate soon, both Onja and Sophie exhibit an exceptional level of dedication to helping those who are most in need.
With first-hand observations of the difference a strong, functioning health center can make in a remote community like Tsaratanana, Sophie and Onja are excited by PIVOT’s plans to reach every health center in Ifanadiana District by 2022. For as long as they continue their work in solidarity with patients and communities, we feel fortunate to have these two remarkable clinicians contributing to PIVOT’s mission in Ifanadiana District.