October 28:

Early up and out the door by around 7am -- we're off to the open
country west of Antananarivo.  It pretty empty land, near a volcano.
This means that the soil is a little better, but not much.  We drive
for two hours to get there, past some beautiful country.  All grassy
hills.  Some of those hills are black from burning -- a major problem.

Before planting, Malagasy folk will burn an area.  It reduces the work
by clearing away scrub and adds nutrients to the soil, but the penalty
paid for all this land clearing is erosion and loss of timber.  I see
fried trees, burnt at the bottom, and fixing to die, but the tops are
still green -- the fire is recent.  In a part of the country with not
nearly enough trees, this is upsetting.  Meanwhile, those trees, as
well as the scrub and other plants help keep what topsoil they have
from washing down and away from the very land they want to plant on.
Meanwhile, in Tana, we smell the burning of land as much as 100
kilometers away.

It's a horrible waste, and I feel guilty as I sniff the air with a
smile, but the local wood, when you burn it, smells like dope.

There are eight of us in the van.  Momy (MAH-MAY), Martin,
Dr. Olivier, his wife, Rivo (REE-VOO), Roget, who is driving, Doug and
Ramona and myself.  I'm so not needed here.  Doug and Ramona are here
for ceremonial reasons; Dr. Olivier is here because of them; Martin is
here to set up a new generator (a larger one, which will support the
computer); Momy is here to do paperwork and get the clinic restocked,
as is Dr. Olivier's wife; Rivo is here to set up the machine; Roget is
driving, and I'm here because these are really nice people who know
I'll appreciate it.

There are a computer, a generator and some boxes of medicine in the
wayback of the van.  This trip takes five hours, minimum: two hours
there and two hours back, and a while to do what you're there to do.
They don't want to waste the time or the gas, so this trip is taking
the place of several.

By the way, gas is about a buck ten a liter.

We pass a US military base.  It dates to the 60's and is not in use
anymore.  Not by troops, anyhow.  The huge parabolic antennae (radio
telescopes?) point up into the sky, still a remnant of the space race
and mission control's need to cover the whole world for following the
progress of the Apollo rockets.  They left 20 years later, when asked
to leave by the Malagasy government.  Nearby is the original
International airport: far from the people of Madagascar, but nice up
snug to the Americans, who, I surmise, built it.

The clinic we arrive at is four rooms.  One for administration, one
for consultation, one for storage and more administration, and one
with four beds for lying-in.  In specific, the room for consultation
is a birthing room, and the one for lying in is where mothers stay for
a few days after giving birth.  It's not a dirty place, but
it's... dark.  Dark and old.  The equipment is old.  The paint faded
and darkened,depending on the original color.  It's not a place
Americans would think of as antiseptic.

And that might be pretty true.  There are squat toilets, but no place
to wash.  Water comes from a well (kept under lock and key in a little
house built over it) via bucket.  Babies don't wear diapers, as is
evidenced by an adorable one-year old fellow crawling on the floor.
Coming ever closer to us -- excited by the strange white woman (he's
probably never seen one before) who coos at him and takes his picture.
He stops for a minute, then starts forward again.  A shiny puddle
stays where he has left.  His mother lifts him up and carts him away,
obviously a little embarrassed.  About him not having a diaper, I
wonder?  Or just the general defecation taboo?

A girl, not more than nine, is holding her infant brother.  They're
both cute, but she's a knockout.  She exchanges smiles with Ramona and
myself, as we take her photo, but we cannot coax speech out of her,
even for something as simple as a name (via our me Tarzan, you Jane,
routine).  Mommy works in the field, so babies are the daughter's
responsibility.  So a 50 pound girl carries a 12 pound baby in when he
is sick.  And she waits for a while with the baby, since the one
doctor here is busy with the foreigners as well as SALFA's staff and
the other folk here who are sick, including the mother with her

A second building sits six meters from clinic.  It's a cook-shack.
Some people come here from far away.  When one person lies here as an
invalid in the four-bed ward, another relative comes to take care of
him or her.  The shack allows her (or him) to cook up something for
the sick person.  There is a man currently in the ward.  He's
been there for a few days.  We're not told why.  We see a young woman
disappear into the cook-shack and re-emerge later with a pot for the
man.  This is a community without microwaves or Tupperware, and it's
only sanitary to eat food freshly cooked.

Signs are plastered on some of the walls with cartoons and simple
statements in Malagasy.  One is a summary of the methods of birth
control, another shows a woman covering her face with her skirt being
told that she should not be ashamed of her TB, a third shows a boy
covering his ears as his friends offer him alcohol, chewing tobacco,
cigarettes, heroin and cannabis.  But there are 10 or so more around,
and two catch my eye -- "Ry Tanora!" (Malagasy for "Hey youngsters!")
"Don't have sex before marriage" and a brutally graphic one with a
man's arm thrusting a knife in a woman's belly, the baby visible
inside, "Ry Tanora!", then "Avoid abortion -- it kills a person" in
Malagasy.  Talking before with Dr. Olivier, I was surprised that US
aid, well known for preaching abstinence, instead of birth control,
helped pay for family planning here.  It makes more sense to me now.

The one doctor who is here has two nurse helpers, but it's she who is
always on call.  She's here five days a week, reduced hours on
Saturday, and Sunday morning from 7:30 to 8:30, so people can get their
meds.  The sign chalked up on the door announces all this, but adds
that she is always available for TB or birthing mothers.  On one hand,
in a tiny town like this you could say, "what else would she do?" but
on the other, you have to admit that this tiny woman has a lot of work
on her hands.

The medicine is expensive, so one man stays here every night, as
security.  He's shorter than me, thinner, and amiable.  We all joke
about the generator -- it's so heavy, we say, as we each work on
lifting it in turn, why didn't you get wheels for this?  It was $20
extra for the wheel, Martin explains.  The wiry security man walks
over and lifts the generator in one pull, holding it up and then sets
it down gently without a groan.

This village of 450 people is in good hands, but it's a hard job, and
the lure of an economy of scale rings in my ears.  Would an ambulance
service be more efficient?  A drugmobile which came at the same time
every day?  But these people don't have telephones, and I doubt many
of them have clocks.